Study On The Idle Peripherally Inserted Central Catheters In Adult Patients

Objective: Increasing studies abroad concern about idle vascular access devices.However,the concept of idle has not been introduced to China.Intravascular catheters retained unnecessarily without medical indication were referred to as “idle” lines.There still scant data on idle PICCs(peripherally inserted central catheters)and the risk of idle PICCs is unknown.Therefore,we used self-made questionnaire to investigate the adult patients with PICCs at five academic tertiary care institutions in Shanghai and assessed the prevalence,risks and risk factors of idle PICC to make up for the blank of domestic research in this aspect,provide information for further study and promote the safe removal of PICCs.Method: Between April 2018 and July 2018,we performed a cross-sectional observational study at five academic tertiary care institutions in Shanghai based on a convenience sampling method.Data were abstracted using a site questionnaire by directly inquiring and medical records reviewing regarding basic patient demographics,and PICCs characteristics(insertion,maintenance and removal information)right after the PICCs were removed.Statistical analysis used SPSS 20.0.Quantitative variables were reported as the mean with standard deviation(SD),whereas categorical variables were expressed as frequency distribution percentage with 95% confidence intervals(CIs).Categorical variables were compared using Chi-square test,continuous variables were compared using Student's t test,Analysis of Variance(ANOVA)or Kruskal-Wallis test.Univariate analysis and Logistic regression analysis were performed to analyze the risk factors of idle PICCs.Result: 358 patients with 358 PICCs episodes who met the inclusion criteria were studied.Of the 58000 total catheter-days recorded,5311(9.2%)were considered as idle based on our study criteria.255(71.2%)patients had at least one idle catheter-day with a mean duration of 14.84(19.31)idle days.The idle days of PICCs in 129(36%)patients were more than 15 days and in 53(14.8%)patients were more than 30 days.The overall incidence of PICC-related complications was 19.8%.There was no statistically significant difference in the incidence of complications between the idle group and the non-idle group(P > 0.05),but the incidence of catheter-related complications in patients with idle PICCs days?15d was higher than that in patients without idle PICCs days<15d(P < 0.05).Logistic regression analysis showed that interpersonal communication,self-reported influence of PICCs,health-payment system,chemotherapy courses,insertion arms and PICC removal advices were the risk factors for idle PICCs,and the idle time of PICC is related to interpersonal communication,self-reported influence of PICCs and PICC removal advices.Conclusion: In conclusion,little attention has been paid to idle PICCs,but idle PICCs were common in adult patients,management and improvement should be made.For patients with stable conditions,PICCs should be removed immediately after the end of treatment to reduce risk of patients.For chemotherapy patients or patients with changeable conditions,the low risks of catheter-related complications may justify maintaining a PICC for further observation when necessary(with 2 weeks of the end of treatment).