Skip to main content Accessibility help

Peripherally Inserted Central Venous Catheter–Associated Bloodstream Infections in Hospitalized Adult Patients

  • M. Cristina Ajenjo (a1) (a2), James C. Morley (a3), Anthony J. Russo (a3), Kathleen M. McMullen (a4), Catherine Robinson (a4), Robert C. Williams (a1) and David K. Warren (a1) (a4)...



Limited data on the risk of peripherally inserted central venous catheter-associated bloodstream infections (PICC BSIs) in hospitalized patients are available. In 2007, dedicated intravenous therapy nurses were no longer available to place difficult peripheral intravenous catheters or provide PICC care Barnes-Jewish Hospital.


To determine the hospital-wide incidence of PICC BSIs and to assess the effect of discontinuing intravenous therapy service on PICC use and PICC BSI rates.


A 1,252-bed tertiary care teaching hospital.


A 31-month retrospective cohort study was performed. PICC BSIs were defined using National Healthcare Safety Network criteria.


In total, 163 PICC BSIs were identified (3.13 BSIs per 1,000 catheter-days). PICC use was higher in intensive care units (ICUs) than non-ICU areas (PICC utilization ratio, 0.109 vs 0.059 catheter-days per patient-day for ICU vs non-ICU; rate ratio [RR], 1.84 [95% confidence interval {CI}, 1.78-1.91]). PICC BSI rates were higher in ICUs (4.79 vs 2.79 episodes per 1,000 catheter-days; RR, 1.7 [95% CI, 1.10-2.61]). PICC use increased hospital-wide after the intravenous therapy service was discontinued (0.049 vs 0.097 catheter-days per patient-day; P = .01), but PICC BSI rates did not change (2.68 vs 3.63 episodes per 1,000 catheter-days; P = .06). Of PICC BSIs, 73% occurred in non-ICU patients.


PICC use and PICC BSI rates were higher in ICUs; however, most of the PICC BSIs occurred in non-ICU areas. Reduction in intravenous therapy services was associated with increased PICC use across the hospital, but PICC BSI rates did not increase.


Corresponding author

Infectious Disease Division, Washington University School of Medicine, Barnes-Jewish Hospital, 660 South Euclid Avenue, Campus Box 8051, St. Louis, MO 63110 (


Hide All

School of Economics, University of New South Wales, Sydney, Australia.



Hide All
1. Turcotte, S, Dube, S, Beauchamp, G. Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg 2006;30(8):16051619.
2. Moureau, N. Vascular safety: it's all about PICCs. Nurs Manage 2006;37(5):2227.
3. Graham, DR, Keldermans, MM, Klemm, LW, Semenza, NJ, Shafer, ML. Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. Am J Med 1991;91(3B):95S100S.
4. Merrell, SW, Peatross, BG, Grossman, MD, Sullivan, JJ, Harker, WG. Peripherally inserted central venous catheters: low-risk alternatives for ongoing venous access. West J Med 1994;160(1):2530.
5. Skiest, DJ, Abbott, M, Keiser, P. Peripherally inserted central catheters in patients with AIDS are associated with a low infection rate. Clin Infect Dis 2000;30(6):949952.
6. Hanna, HA, McFadyen, S, Marts, K, Richardson, D, Raad, II. Prospective evaluation of 1.67 million catheter-days of PICCs in cancer patients: long durability and low infection rate. In: Program and abstracts of the 41th Interscience Conference on Antimicrobial Agents and Chemotherapy. 2001. Abstract K-2045.
7. Lam, S, Scannell, R, Roessler, D, Smith, MA. Peripherally inserted central catheters in an acute-care hospital. Arch Intern Med 1994;154(16):18331837.
8. Todd, J. Peripherally inserted central catheters and their use ini.v. therapy. Br J Nurs 1999;8(3):140148.
9. Philpot, P, Griffiths, V. The peripherally inserted central catheter. Nurs Stand 2003;17(44):3946.
10. Todd, J, Hammond, P. Choice and use of peripherally inserted central catheters by nurses. Prof Nurse 2004;19(9):493497.
11. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hasp Epidemiol 2002;23(12):759769.
12. Cardella, JF, Cardella, K, Bacci, N, Fox, PS, Post, JH. Cumulative experience with 1,273 peripherally inserted central catheters at a single institution. J Vase Interv Radiol 1996;7(1):513.
13. Royer, T. Nurse-driven interventional technology: a cost and benefit perspective. J Infus Nurs 2001;24(5):326331.
14. Gabriel, J. Peripherally inserted central catheters: expanding UK nurses’ practice. Br J Nurs 1996;5(2):7174.
15. Cheong, K, Perry, D, Karapetis, C, Koczwara, B. High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours. Intern Med 2004;34(5):234238.
16. Walshe, LJ, Malak, SF, Eagan, J, Sepkowitz, KA. Complication rates among cancer patients with peripherally inserted central catheters. J Clin Oncol 2002;20(15):32763281.
17. Snelling, R, Jones, G, Figueredo, A, Major, P. Central venous catheters for infusion therapy in gastrointestinal cancer: a comparative study of tunnelled centrally placed catheters and peripherally inserted central catheters. J Intraven Nurs 2001;24(1):3847.
18. Cowl, CT, Weinstock, JV, Al-Jurf, A, Ephgrave, K, Murray, JA, Dillon, K. Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters. Clin Nutr 2000;19(4):237243.
19. Griffiths, VR, Philpot, P. Peripherally inserted central catheters (PICCs): do they have a role in the care of the critically ill patient? Intensive Crit Care Nurs 2002;18:3747.
20. Safdar, N, Maki, DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128(2):489495.
21. Kahn, MG, Steib, SA, Dunagan, WC, Fraser, VJ. Monitoring expert system performance using continuous user feedback. J Am Med Inform Assoc 1996;3(3):216223.
22. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309332.
23. Rosner, B. Fundamentals of biostatistics. 5th ed. Pacific Grove, CA: Duxbury Press, 2000.
24. Ryder, MA. Peripheral access options. Surg Oncol Clin N Am 1995;4(3):395427.
25. Vanek, VW. The ins and outs of venous access: part II. Nutr Clin Pract 2002;17(3):142155.
26. Harter, C, Ostendorf, T, Bach, A, Egerer, G, Goldschmidt, H, Ho, AD. Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with hae-matological malignancies. Support Care Cancer 2003;11(12):790794.
27. Edwards, JR, Peterson, KD, Andrus, ML, Dudeck, MA, Pollock, DA, Horan, TC. National Healthcare Safety Network (NHSN) report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36(9):609626.
28. Marschall, J, Leone, C, Jones, M, Nihill, D, Fraser, VJ, Warren, DK. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol 2007;28(8):905909.
29. Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24(12):942945.
30. Vonberg, RP, Behnke, M, Geffers, C, et al. Device-associated infection rates for non-intensive care unit patients. Infect Control Hosp Epidemiol 2006;27(4):357361.
31. Barber, JM, Booth, DM, King, JA, Chakraverty, S. A nurse led peripherally inserted central catheter line insertion service is effective with radiological support. Clin Radiol 2002;57(5):352354.
32. Barber, D. The extended role of the nurse: practical realities. Hum Fértil (Camb) 2002;5(1):1316.
33. Funk, D, Gray, J, Plourde, PJ. Two-year trends of peripherally inserted central catheter line complications at a tertiary-care hospital: role of nursing expertise. Infect Control Hosp Epidemiol 2001;22(6):377379.
34. Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S22S30.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed