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Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study
  1. Sarah L Krein1,2,
  2. Sanjay Saint1,3,
  3. Barbara W Trautner4,5,
  4. Latoya Kuhn1,
  5. John Colozzi1,
  6. David Ratz1,
  7. Erica Lescinskas5,
  8. Vineet Chopra1,3
  1. 1 Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2 Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3 Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  4. 4 Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  5. 5 Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Sarah L Krein, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; skrein{at}umich.edu

Abstract

Objective Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation.

Design Prospective cohort study.

Setting Inpatient medical units at four US hospitals in two states.

Participants Consecutive sample of patients who had a new PICC placed during a hospital stay between August 2015 and May 2017.

Main outcome(s) Patient-reported signs and symptoms of a possible PICC-related complication or functional issues.

Results Of the 438 patients in the analytic cohort (91.4% of those consented), two-thirds were male with a mean age of 56 years. The most common reason for PICC placement was long-term antibiotic therapy (43.4%). During the 70-day follow-up period, 61.4% of patients reported signs of at least one complication, including potentially serious complications, such as bloodstream infection (17.6%) and deep vein thrombosis (30.6%). Correspondence of these reported events with medical record documentation of the complication was generally low. More than one-quarter (27.9%) of patients reported minor complications, such as insertion site redness, discomfort or difficult removal. While the PICC was in place, 26.0% reported restrictions in activities of daily living, 14.4% social activity restrictions and 19.2% had difficulty with flushing or operating the PICC.

Conclusion Over 60% of patients report signs or symptoms of a possible complication or adverse effect after PICC placement. Bothersome complications from the patient perspective are clearly more common than those that typically rise to the level of healthcare provider attention or concern. Understanding the patient experience is critical for providing safe and effective care.

  • adverse events, epidemiology and detection
  • nosocomial infections
  • patient-centred care
  • patient safety

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

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Footnotes

  • Contributors The authors thank the following individuals who assisted with data collection and other study-related activities: Laura Dillon, Jeanaya McKinley, Laura Peña, Jason Mann, Marylena Rouse, Kathy Swalwell, Suzanne Winter, Jane Wong, Debbie Zawol and Karen Fowler. They also thank the patients who so graciously participated and provided data for this study.

  • Funding This study was funded by the US Department of Veterans Affairs (VA) Health Services Research and Development Service (grant numbers IIR 12-395 and RCS 11-222) with additional support provided by the VA National Center for Patient Safety through a Patient Safety Center of Inquiry.

  • Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review board approval was received from each participating hospital: VA Ann Arbor Healthcare System, University of Michigan Medical School IRB, Baylor College of Medicine IRB and Harris Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Deidentified data will be made available after all ongoing analyses are completed. Requesters will be required to sign a Letter of Agreement detailing the mechanisms by which the data will be kept secure and access restricted to their study team. The agreements will also state the recipient will not attempt to identify any individual whose data are included and will not share the data with anyone outside of their research team. The data set will not include PII and all dates removed.

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