Hospitals may reduce the risk of life-threatening bloodstream infections in newborns with peripherally inserted central venous catheters by replacing the device every 30 days or so, according to a new Johns Hopkins Children's Center study.
The daily risk of getting a dangerous bacterial infection jumped by 33 percent per day around day 35 and remained elevated thereafter in those babies who needed the device long term, the investigators write in the April issue of Pediatrics. Their findings will appear online on March 15.
A peripherally inserted central venous catheter, or a "PICC" line, is a tube inserted into a peripheral blood vessel in the arm or forearm, and threaded toward the major blood vessels near the lungs and heart. The device provides a temporary portal for medications, food, fluids and blood-draws in critically ill newborns. Because central lines also provide quick access in emergencies, newborns in the neonatal intensive care unit often need the device for weeks or months. However, with prolonged use, the line can become contaminated and allow dangerous bacteria direct entry into a baby's bloodstream.
"Our findings showed a dramatic increase in daily infection risk for each day beyond day 35," says lead investigator Aaron Milstone, M.D., M.H.S., a pediatric infectious disease specialist at Hopkins Children's. "Our message to NICU staff is simple: Remain vigilant and consider replacement around day 35."
But investigators caution there is no magic day for removing catheters in order to prevent infections. Instead, they advise doctors and nurses to be vigilant about signs of infection, to reassess daily the risk versus the benefit of catheter use in each patient, and to remove the catheter immediately once no longer needed.