A longer dwell time for peripherally inserted central catheters in newborns does not appear to increase the risk of central line-associated bloodstream infections (CLABSIs), according to a recent study.
“Replacing catheters unnecessarily is dangerous. Our data indicate that clinicians should not routinely replace uninfected peripherally inserted central catheters (PICC) for fear of infection,” Dr. Rachel G. Greenberg of the Duke University School of Medicine in Durham, N.C., and her associates reported online.
“Our finding of a lack of association for PICC line infections with dwell time suggests that clinicians should focus their efforts to reduce CLABSI on both proper line maintenance and timely central line removal when the line is no longer needed,” the authors wrote (Pediatrics 2015 Nov. 16 [doi: 10.1542/peds.2015-0573]).
The risk for CLABSIs with tunneled catheters, however, did increase significantly in weeks 7 and 9, the researchers found.
“Our data suggest that although there may be compelling reasons to leave a tunneled catheter in place, daily consideration should be given to the necessity of a tunneled catheter weighed against the increased risk for infection that develops in the sixth week of dwell time,” Dr. Greenberg and her colleagues wrote.
The researchers retrospectively analyzed the rate of CLABSIs among 13,327 infants, with a median age of 29 weeks, in 141 NICUs in 13 states from September 2011 to August 2013. The infants had 15,567 catheters, 93% of which were PICCs and 7% of which were tunneled catheters, for a total of 256,088 catheter days.
The median dwell time for PICCs was 11 days, compared to 25 days for the tunneled catheters, a significant difference. A total of 87 PICCs and 124 tunneled catheters had dwell times over 10 weeks.
CLABSIs occurred 2.4 times more often with tunneled catheters (3.5%) than with PICCs (1.4%), but CLABSI rates varied considerably across different NICUs. Just under half the NICUs (47%) had no CLABSIs. With an overall rate of 0.93 CLABSIs per 1,000 catheter days, the researchers did not find a positive correlation between dwell time and CLABSI risk from PICCs.
The risk of CLABSI for tunneled catheters was significantly higher during weeks 7 (hazard ratio: 4.0) and 9 (HR: 4.7), compared with week 1. The overall risk of CLABSIs was significantly four times greater for infants born from 26 to 29 weeks (HR: 3.9) and six times greater for infants born before 26 weeks (HR: 6.1), but preterm infants had no higher risk of CLABSIs from tunneled catheters.
“We postulate that the significant maturational changes in the immune system that occur in the early neonatal period, particularly in premature infants, may lead to decreased risk of infection as the infant ages with the central line in place,” the authors wrote. “Increased enteral feeds and decreased acuity of illness over time may also lead to fewer times the line is accessed and therefore less frequent opportunities to introduce infection,” they continued. “Finally, maturation of the gastrointestinal system in older infants may lead to less translocation of bacteria and decreased risk for infection.”
The research was funded by the National Institutes of Health, the Health Research & Educational Trust. Dr. Smith receives research funding from Cempra Pharmaceuticals and other industry for pediatric drug development.