Early Removal of Pediatric Catheters Key to Infection Prevention

Hospitals can reduce life-threatening bloodstream infections in children with peripherally inserted central venous catheters by removing the devices as early as possible, according to a Johns Hopkins Children's Center study in the journal Clinical Infectious Diseases.

The study, believed to be the largest of its kind in pediatric patients, analyzed predictors of catheter-related bloodstream infections among 1,800 children treated at Hopkins over six years. The children cumulatively underwent more than 2,590 catheter insertions, which resulted in a total of 116 infections.

One potent predictor of infection was length of use, the researchers found. Children whose devices remained in for three weeks or longer were 53% more likely to get a bloodstream infection, compared with those with shorter catheter times. Children who got the catheters to receive IV nutrition were more than twice as likely to get an infection as children who had the devices placed for other reasons, the study found.

The findings of the study underscore the need for a tailored approach to each patient while at the same time following standard infection prevention guidelines, the study's authors said. "Clinicians should evaluate each patient's condition daily and weigh the risk of leaving the device in against the risk of removing it by asking a simple question 'Does this child need a central line for another day?'" says senior author Aaron Milstone, M.D., M.H.S., an infectious disease specialist at Hopkins Children's.

No matter the length of PICC use, the first line of defense against bloodstream infections should always be simple precautions that include rigorous hand-washing before handling the line, regularly changing the dressing that covers the PICC line, and periodically changing the tubes and caps attached to it, the researchers said.

"Even when clinicians follow meticulously basic rules of catheter insertion and maintenance, the risk of infection is never zero," Milstone said. "Reducing the time a child has a PICC is one extra step to minimize that risk."

Researchers found an 80% higher risk of bloodstream infections among children in the ICU than in regular units. However, the study also showed that more than 30% of all infections occurred in children outside of the ICU. Twenty-two percent of infections occurred after patients left the hospital, the researchers found, a finding that points to the importance of educating both parents and home-based caregivers on ways to prevent infections at home.

"Children in intensive care have more severe disease and often require catheters, but it is critical that we remain vigilant about patients with perceived 'lower risk' outside of intensive care, and indeed those outside of the hospital, because they are not immune to infections," said lead investigator Sonali Advani.