Purpose or Case Report: Preservation of venous access in children is a major concern in pediatric interventional radiology. If a peripherally inserted central catheter (PICC) breaks, there are two options: repair the line with a repair kit or exchange the line over a wire in the interventional suite. The purpose of this study is to explore the outcome (patency, success and infection) of PICC repairs in children and to compare those risks to that of PICC exchange.
Methods & Materials: Single center, retrospective study of central line-associated bloodstream infection (CLABSI) following management of externally broken PICCs (2010 – 2014). The occurrence of CLABSI within 30 days after repair (Group A) or exchange (Group B) of a line were analyzed. Additionally, rates of lines which reached end of treatment were calculated.
Results: 235 PICC breaks were included in the study, of which 161 were repaired, and 116 of whom were successful (68%, Group A). No repair was performed in 74 PICCs - 55/74 of these were exchanged over a wire (74%, Group B). The 30 days post-repair CLABSI rate was 2.0 infections per 1000 catheter days and the calculated risk was 4.3% (Group A). In comparison the 30 days post-exchange CLABSI rate was 4.0 per 1000 catheter days and the calculated risk 10.9% (Group B). After adjusting for antibiotics an almost four-fold increase in risk of a CLABSI was found in a timeframe 30 days after an external PICC breakage and subsequent line exchange compared to a subsequent line repair (OR 3.87; 95% CI: 1.07 – 14.0, p=0.039).
Conclusions: The results showed a higher rate of infection associated with a PICC exchange compared to a PICC repair. This finding encourages nurses and physicians to repair a broken PICC instead of removing or replacing the PICC.