1. Texas Pediatric Society Electronic Poster Contest
Role of a Single Prophylactic Dose of Vancomycin in the Prevention of Neonatal Sepsis Associated with Peripherally Inserted Central Venous Catheter Removal
Lovya George MBBS1, Michael H Malloy MD2, Rafael A Fonseca MD2
Department of Pediatrics1, Division of Neonatology2
The University of Texas Medical Branch, Galveston, Texas 77555
INTRODUCTION
Central line associated bloodstream infections (CLABSI) continue to be a significant source of morbidity and healthcare cost in the neonatal ICU.
It has been hypothesized that removal of a central catheter itself can potentially be associated with blood stream infections due to disruption of a biofilm formed on the catheter during indwell, resulting in an influx of bacteria into the patient’s bloodstream. 3,5
There is no uniform consensus on measures to prevent such infections, potentially associated with removal of a Peripherally Inserted Central Venous Catheter( PICC). 1-5
ABSTRACT
A retrospective chart review study to determine whether a single dose of Vancomycin prior to PICC removal had any role in preventing potential sepsis associated with removal of the PICC. We collected data from 240 infants and compared outcomes between the infants who received a single dose of Vancomycin at the time of PICC removal and the infants who did not. Primary outcomes measured included culture positive sepsis as well as sepsis evaluations within 72 hours of removal of the PICC line. There was no statistically significant difference between both groups in terms of sepsis evaluations (p = 0.78) or with regard to culture proven sepsis (p = 0.76).
Among infants who received a dose of Vancomycin prior to PICC line removal there were 10 sepsis evaluations and 3 episodes of culture positive sepsis within 72 hrs of PICC removal where as the group that did not get Vancomycin had 4 sepsis evaluations and 1 episode of culture proven sepsis.
There were a total of 14 CLABSI incidents in the 201 infants included in data analysis (6.97%).
4 out of the total 14 episodes of CLABSI occurred within 72 hours of PICC line removal (28.5% ).
AIM
To examine the role of a single prophylactic dose of Vancomycin prior to PICC removal in preventing potential sepsis associated with removal of the PICC.
METHODS
Retrospective cohort study, reviewing medical records of all infants admitted to UTMB Level III NICU between 9/2011 and 12/2013 and had a PICC line in place > 48 hrs (240 infants).
In UTMB NICU infants may or may not get a single 20 mg/kg IV dose of Vancomycin prior to PICC removal based on attending practice preferences.
Following outcomes were evaluated:
Culture positive sepsis AND
Number of sepsis evaluations, occurring within 72 hrs of PICC removal
CONCLUSIONS
No statistically significant difference between the two groups in terms of culture positive sepsis within 72 hrs of pulling the PICC ( p =0.76 )
No significant difference between the two groups in terms of sepsis evaluations within 72 hrs of pulling the PICC line ( p = )
Length of stay is longer in infants who develop a CLABSI (p = 0.036)
Duration of indwell of the PICC is more in infants who develop a CLABSI ( p = 0.045)
Infants who developed a CLABSI were on TPN for a longer duration ( p = 0.005)
The results of this study do not support the routine administration of a prophylactic dose of Vancomycin at the time of PICC removal
RESULTS
137 infants got a single dose of Vancomycin prior to removal of PICC line and 64 infants did not. 39 infants were excluded from data analysis as they were already on Vancomycin at the time of PICC removal.
The two groups did not have any statistically significant difference in demographics including birth weight, duration of PICC, days of TPN or total length of stay.
Mean birth weight was lower and length of stay was longer for infants who developed culture positive sepsis in the 72 hrs after PICC removal but this difference was not statistically significant.
REFERENCES
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Hemela MAC, Hoogen A, Verboon- Maciolek MA, Fleer A, Krediet TG . Pediatric Critical Care Medicine 2011;12(4):
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Craft AP, Finer NN, Barrington KJ. Cochrane Database Syst Rev 2000;2:CD001971
Garland JS, Alex CP, Henrickson KJ etal. Pediatrics 2005;116:
Texas Pediatric Society Electronic Poster Contest