Are Peripherally inserted central catheters associated with increased risk of adverse events in status 1B patients awaiting transplantation on continuous intravenous milrinone?

Nicholas A. Haglund, Zachary L. Cox, Jeff T. Lee, Yanna Song, Mary E. Keebler, Thomas G. Disalvo, Simon Maltais, Daniel J. Lenihan, Mark A. Wigger

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Peripherally inserted central catheters (PICCs) are used to deliver continuous intravenous (IV) milrinone in stage D heart failure (HF) patients awaiting heart transplantation (HT). Methods: We retrospectively analyzed PICC adverse events (AEs) and associated cost in 129 status 1B patients from 2005 to 2012. End points were HT, left ventricular assist device (LVAD), and death. Regression analysis was used to identify AE risk factors. Results: Fifty-three PICC AEs occurred in 35 patients (27%), consisting of 48 infections, 4 thromboses, and 1 bleeding event. Median duration of PICC support was 63 (interquartile range [IQR] 34-131) days, and median time to first PICC infection was 44 (IQR 14-76) days. Among PICC infections, 9% required defibrillator removal and 30% were inactivated on the HT list for a mean of 23 6 17 days. Rate of HT, LVAD, or death was similar between groups (P >.05). Regression analysis found that a double lumen PICC was associated with a shorter time to first PICC infection (hazard ratio 7.59, 95% CI 1.97-29.23; P 5.003). Median cost per PICC infection was $10,704 (IQR $7,401-$26,083). Conclusions: PICC infections were the most frequent AEs. PICCs with >1 lumen were associated with increased risk of infection. PICC AEs accounted for increased intensive care unit admissions, HT list inactivations, and overall cost.

Original languageEnglish (US)
Pages (from-to)630-637
Number of pages8
JournalJournal of Cardiac Failure
Volume20
Issue number9
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Milrinone
Catheters
Transplantation
Heart Transplantation
Infection
Heart-Assist Devices
Costs and Cost Analysis
Regression Analysis
Defibrillators
Intensive Care Units

Keywords

  • Heart failure
  • Infection
  • Inotrope
  • Peripherally inserted central catheter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Are Peripherally inserted central catheters associated with increased risk of adverse events in status 1B patients awaiting transplantation on continuous intravenous milrinone? / Haglund, Nicholas A.; Cox, Zachary L.; Lee, Jeff T.; Song, Yanna; Keebler, Mary E.; Disalvo, Thomas G.; Maltais, Simon; Lenihan, Daniel J.; Wigger, Mark A.

In: Journal of Cardiac Failure, Vol. 20, No. 9, 01.01.2014, p. 630-637.

Research output: Contribution to journalArticle

Haglund, Nicholas A. ; Cox, Zachary L. ; Lee, Jeff T. ; Song, Yanna ; Keebler, Mary E. ; Disalvo, Thomas G. ; Maltais, Simon ; Lenihan, Daniel J. ; Wigger, Mark A. / Are Peripherally inserted central catheters associated with increased risk of adverse events in status 1B patients awaiting transplantation on continuous intravenous milrinone?. In: Journal of Cardiac Failure. 2014 ; Vol. 20, No. 9. pp. 630-637.
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abstract = "Background: Peripherally inserted central catheters (PICCs) are used to deliver continuous intravenous (IV) milrinone in stage D heart failure (HF) patients awaiting heart transplantation (HT). Methods: We retrospectively analyzed PICC adverse events (AEs) and associated cost in 129 status 1B patients from 2005 to 2012. End points were HT, left ventricular assist device (LVAD), and death. Regression analysis was used to identify AE risk factors. Results: Fifty-three PICC AEs occurred in 35 patients (27{\%}), consisting of 48 infections, 4 thromboses, and 1 bleeding event. Median duration of PICC support was 63 (interquartile range [IQR] 34-131) days, and median time to first PICC infection was 44 (IQR 14-76) days. Among PICC infections, 9{\%} required defibrillator removal and 30{\%} were inactivated on the HT list for a mean of 23 6 17 days. Rate of HT, LVAD, or death was similar between groups (P >.05). Regression analysis found that a double lumen PICC was associated with a shorter time to first PICC infection (hazard ratio 7.59, 95{\%} CI 1.97-29.23; P 5.003). Median cost per PICC infection was $10,704 (IQR $7,401-$26,083). Conclusions: PICC infections were the most frequent AEs. PICCs with >1 lumen were associated with increased risk of infection. PICC AEs accounted for increased intensive care unit admissions, HT list inactivations, and overall cost.",
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AU - Haglund, Nicholas A.

AU - Cox, Zachary L.

AU - Lee, Jeff T.

AU - Song, Yanna

AU - Keebler, Mary E.

AU - Disalvo, Thomas G.

AU - Maltais, Simon

AU - Lenihan, Daniel J.

AU - Wigger, Mark A.

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N2 - Background: Peripherally inserted central catheters (PICCs) are used to deliver continuous intravenous (IV) milrinone in stage D heart failure (HF) patients awaiting heart transplantation (HT). Methods: We retrospectively analyzed PICC adverse events (AEs) and associated cost in 129 status 1B patients from 2005 to 2012. End points were HT, left ventricular assist device (LVAD), and death. Regression analysis was used to identify AE risk factors. Results: Fifty-three PICC AEs occurred in 35 patients (27%), consisting of 48 infections, 4 thromboses, and 1 bleeding event. Median duration of PICC support was 63 (interquartile range [IQR] 34-131) days, and median time to first PICC infection was 44 (IQR 14-76) days. Among PICC infections, 9% required defibrillator removal and 30% were inactivated on the HT list for a mean of 23 6 17 days. Rate of HT, LVAD, or death was similar between groups (P >.05). Regression analysis found that a double lumen PICC was associated with a shorter time to first PICC infection (hazard ratio 7.59, 95% CI 1.97-29.23; P 5.003). Median cost per PICC infection was $10,704 (IQR $7,401-$26,083). Conclusions: PICC infections were the most frequent AEs. PICCs with >1 lumen were associated with increased risk of infection. PICC AEs accounted for increased intensive care unit admissions, HT list inactivations, and overall cost.

AB - Background: Peripherally inserted central catheters (PICCs) are used to deliver continuous intravenous (IV) milrinone in stage D heart failure (HF) patients awaiting heart transplantation (HT). Methods: We retrospectively analyzed PICC adverse events (AEs) and associated cost in 129 status 1B patients from 2005 to 2012. End points were HT, left ventricular assist device (LVAD), and death. Regression analysis was used to identify AE risk factors. Results: Fifty-three PICC AEs occurred in 35 patients (27%), consisting of 48 infections, 4 thromboses, and 1 bleeding event. Median duration of PICC support was 63 (interquartile range [IQR] 34-131) days, and median time to first PICC infection was 44 (IQR 14-76) days. Among PICC infections, 9% required defibrillator removal and 30% were inactivated on the HT list for a mean of 23 6 17 days. Rate of HT, LVAD, or death was similar between groups (P >.05). Regression analysis found that a double lumen PICC was associated with a shorter time to first PICC infection (hazard ratio 7.59, 95% CI 1.97-29.23; P 5.003). Median cost per PICC infection was $10,704 (IQR $7,401-$26,083). Conclusions: PICC infections were the most frequent AEs. PICCs with >1 lumen were associated with increased risk of infection. PICC AEs accounted for increased intensive care unit admissions, HT list inactivations, and overall cost.

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