Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters.

Little is known about peripherally inserted central catheter (PICC) use, appropriateness and device outcomes in Brazil. We conducted an observational, prospective, cohort study spanning 16 Brazilian hospitals from October 2018 to August 2020. Patients ≥18 years receiving a PICC were included. PICC placement variables were abstracted from medical records. PICC-related major (deep vein thrombosis (DVT), central line-associated bloodstream infection (CLABSI) and catheter occlusion) and minor complications were collected. Appropriateness was evaluated using the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Devices were considered inappropriate if they were in place for <5 days, were multi-lumen, and/or were placed in patients with a creatinine >2.0 mg/dL. PICCs considered appropriate met none of these criteria. Mixed-effects logistic regression models adjusting for patient-level and hospital-level characteristics assessed the association between appropriateness and major complications. Data from 12 725 PICCs were included. Mean patient age was 66.4±19 years and 51.0% were female. The most common indications for PICCs were intravenous antibiotics (81.1%) and difficult access (62.7%). Most PICCs (72.2%) were placed under ultrasound guidance. The prevalence of complications was low: CLABSI (0.9%); catheter-related DVT (1.0%) and reversible occlusion (2.5%). Of the 12 725 devices included, a total of 7935 (62.3%) PICCs were inappropriate according to MAGIC. With respect to individual metrics for appropriateness, 17.0% were placed for <5 days, 60.8% were multi-lumen and 11.3% were in patients with creatinine >2.0 mg/dL. After adjusting for patient and hospital-level characteristics, multi-lumen PICCs considered inappropriate were associated with greater odds of major complications (OR 2.54, 95% CI 1.61 to 4.02). Use of PICCs in Brazilian hospitals appears to be safe and comparable with North America. However, opportunities to improve appropriateness remain. Future studies examining barriers and facilitators to improving device use in Brazil would be welcomed. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Citation

Eneida Rejane Rabelo-Silva, Solange Antonia Lourenço, Rubia Natasha Maestri, Claudia Candido da Luz, Vanderlei Carlos Pupin, Raquel Bauer Cechinel, Eduarda Bordini Ferro, Marco Aurélio Lumertz Saffi, Telma Christina do Campo Silva, Larissa Martins de Andrade, Larissa Fernanda Sales Gomes, Lorena Alves da Gama, Mariana Marques de Araújo, Fábio Rodrigues Ferreira do Espírito Santo, Leticia López Pedraza, Vânia Naomi Hirakata, Vilma Santana Soares, Widlani Sousa Montenegro, Gustavo Rocha Costa de Freitas, Thaís Souza de Jesus, Vineet Chopra, PICC-Brazil Research Group. Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters. BMJ quality & safety. 2022 Sep;31(9):652-661

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PMID: 35086961

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