Experience Using Peripherally Inserted Central Venous Catheters for Outpatient Parenteral Antibiotic Therapy in Children at a Community Hospital

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Abstract
Outpatient parenteral antibiotic therapy with peripherally inserted central catheters (PICCs) is safe, clinically effective, and cost effective in pediatric populations cared for at academic and free-standing pediatric hospitals. Our study evaluates the transferability of these findings to a community hospital setting. Data were retrospectively collected on PICCs used in children at a community hospital from December 2003 to September 2006. The Fisher exact test and a logistic regression were used for statistical analysis. Thirty-nine PICCs were placed in 34 patients. The total number of catheter days at home was 800 (mean 20.5 +/- 13.9). We demonstrated a 97% success rate in completing therapy at home, with 82.3% completion with a single PICC. Our overall complication rate was 33.3%, consisting of occlusion, accidental displacement, cracks in the catheters, and local irritation. There were no instances of phlebitis or suspected or confirmed catheter infection or sepsis. There were no statistically significant differences in these values compared with reports from major pediatric centers. The cost savings was $1070 per day of home health care when compared with costs of inpatient hospitalization. We believe that this is the first study to demonstrate the effectiveness of PICC use for outpatient parenteral antibiotic therapy in pediatric patients in a community hospital setting, and demonstrates the ability for this to be done at the standard of care expected at major pediatric centers.

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