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allied
academies
August 23-24, 2018 | London, UK
Hematology and Oncology
2
nd
International Conference on
Journal of Hematology and Blood Disorder | Volume 2
PICCs & Central Line Associated Blood Stream Infections in Aneurin Bevan Health Board
Richard Fenton
Royal Gwent Hospital, UK
P
eripherally inserted central catheters (PICCs) are specialised
venous catheters made of strong, flexible, radio-opaque
material such as polyurethane or silicone. They terminate
in the distal superior vena cava and provide reliable venous
access for the delivery of a broad range of intravenous agents;
they also allow blood to be safely drawn for laboratory
testing. The popularity of PICCs has grown in contemporary
medical practice for numerous reasons such as relative cost-
effectiveness, perceived safety and ease of insertion. They have
taken over from traditional central venous catheters (CVCs)
which are inserted by directly puncturing one of the great
veins at the upper thoracic aperture. Central line-associated
blood stream infection (CLABSI) is one of the major potential
complications among all CVCs, particularly among critically ill
or immunocompromised patients. This quality improvement
project aims to review CLABSI rates in PICC lines inserted in The
Royal Gwent Hospital & implement interventions to reduce the
rate of infection. A retrospective data collection was carried
out identifying all patients who had received a PICC line in the
year running January to January 2016-2017. This period was
chosen because it was the first year in which more than 50
PICCs were inserted by the Radiologists and it was felt that a
sample size of less than 50 could provide inadequate or biased
data. 54 patients from the Radiology database and 54 patients
from the Haematology database were randomly selected and
comprehensive data was extracted from CWS, RADEX and
patient notes. Interventions were then implemented including
updating guidelines for PICC care on the intranet, producing a
proforma for use in patient’s notes and organising teaching at
Foundation Doctor weekly sessions as well as on the wards.
Data was then collected again to assess the effect of the
interventions and run-charts were produced to demonstrate
significance. Results Four lines in the initial data collection
fulfilled the criteria for CLABSI. Three of these infections were
for PICC lines from the Haematology arm and one was from a
PICC line from the Radiology arm. Since PICCs are present for
a varying duration in different patients, expressing the risk of
CLABSI per 1,000 line days rather than per 100 PICCs allows
for a more meaningful estimation of risk. The overall rate of
infection was 0.92 infections per 1,000 line days with a rate of
1.05 infections per 1,000 line days in the Haematology arm and
0.67 infections per 1,000 line days in the Radiology arm. The
subsequent data collection demonstrated an overall rate of
infection of 0.76 infections per 1,000 line dayswith a rate of 0.94
infections per 1,000 line days in the Haematology arm and 0.45
infections per 1,000 line days in the Radiology arm. Discussion
In both The Radiology Suite andMedical Day Case Unit, the rate
of proven CLABSI is <1.2 per 1,000 line days which is far superior
to the average quoted in the literature of 2.1 per 1,000 line days
(3) in hospitalised patients. However, as the data was gathered
it became apparent that there were multiple PICC lines which
were removed for suspicion of infection in which the line was
not sent for culture. Therefore, the apparently favourable
rates of line infection at RGH may merely be an anomaly due
to poor practice with regards to microbiological protocol. All
lines which are removed for suspicion of CLABSI must be sent
to microbiology for line-tip culture, along with a simultaneous
blood culture ideally taken prior to line removal. It is prudent
to note that if there is no demonstrable advantages in terms of
outcomes when placing PICC lines in Interventional Radiology
Suites then the procedure could simply be completed at the
bedside by specially trained nurses. However, the data collected
through this project showed that there were significantly fewer
infectionsper1,000linesdayswhenPICClineswereplacedinThe
Radiology Suite. While this may justify the extra cost involved,
it may simply reflect the different subgroups of the population
admitted into the twodifferent services. Themajorityof patients
undergoing PICC line insertion in Medical Day Case Unit require
long-term chemotherapy and are therefore more susceptible
to CLABSI. In addition, patients who are frailer, hospitalised,
more elderly or suffering from concurrent infections are more
likely to contract CLABSI. The overall average time until infection
was 57 days with the longest time until infection being 134
days and the shortest being 11 days. An early infection (within
two weeks) would suggest that it was procedure-related.
e:
Richard.fenton@wales.nhs.uk