(778) Use of Peripherally Inserted Central Catheters in Infants: PICC Study

Introduction: The use of peripherally inserted central catheters (PICCs) has grown in pediatric inpatient settings. Despite the advantages associated with its use, the risk of complications, such as catheter-related venous thrombosis (CRT), may be higher compared with untunneled or tunneled central venous catheters (CVCs). In preparation for a future trial of thromboprophylaxis in infants with PICC, we aimed to characterize the use and outcomes of PICC in hospitalized infants.

Methods: Following IRB approval, we retrospectively studied infants < 1 year old admitted to 9 children’s hospitals from January 2017- December 2020 who had a PICC. We excluded infants < 34 weeks corrected gestational age and subsequent PICC insertion. Eligible infants were identified from the electronic medical records using CPT/ICD-10 codes. We collected demographics, PICC characteristics, laboratory results, interventions, and outcome variables. Descriptive statistics were used to analyze the data.

Results: A total of 350 infants with PICC were enrolled in the study. The median age of the cohort was 19 (interquartile range: 5-97) days. Among the cohort, 57% were males, and 44% were non-Hispanic white race. About 52% were in the neonatal intensive care unit (ICU) and 27% in pediatric ICU at the time of PICC insertion. Twenty one percent were post-surgical. Prior to PICC insertion, 8.3% had bleeding, and 3.7% had a history of thrombosis. Infection (114, 32.7%) was the most common diagnosis, followed by cardiac (63, 18.1%). The most common indications for PICC were prolonged parenteral infusion (205, 58.4%) and difficult venous access (153, 43.6%). Most PICCs were less than 2 Fr (163, 46.4%), single lumen (268, 76.4%), and were inserted in the upper extremity. Two-thirds of PICCs were removed after completion of treatment and mostly while the infant was still hospitalized. Of the different complications associated with the PICC, CRT developed in 14 infants (2.6%), clinically relevant bleeding in 1 (0.3%), and catheter-associated bloodstream infection in 8 (1.7%).

Conclusions: PICCs are commonly inserted in critically ill infants. The frequency of CRT in this cohort suggests that a targeted, rather than a routine, approach to its prevention is needed.