Cost-effectiveness Analysis of Peripherally Inserted Central Catheters Versus Central Venous Catheters for in-Hospital Parenteral Nutrition.
Journal
Journal of patient safety
ISSN: 1549-8425
Titre abrégé: J Patient Saf
Pays: United States
ID NLM: 101233393
Informations de publication
Date de publication:
01 10 2022
01 10 2022
Historique:
pubmed:
20
5
2022
medline:
1
10
2022
entrez:
19
5
2022
Statut:
ppublish
Résumé
Our objective was to evaluate the cost-effectiveness of the use of peripherally inserted central venous catheters (PICCs) by a vascular access team (VAT) versus central venous catheters (CVCs) for in-hospital total parenteral nutrition (TPN). The study used a cost-effectiveness analysis based on observational data retrospectively obtained from electronic medical records from 2018 to 2019 in a teaching hospital. We included all interventional procedures requiring PICCs or CVCs with the indication of TPN. We recorded the costs of insertion, maintenance, removal, and complications. The main outcome measure was the incidence rate of catheter-associated bacteremia per 1000 catheter days. Cost-effectiveness analysis was performed from the hospital perspective within the context of the publicly funded Spanish health system. Confidence intervals for costs and effectiveness differences were calculated using bootstrap methods. We analyzed 233 CVCs and 292 PICCs from patients receiving TPN. Average duration was longer for PICC (13 versus 9.4 days, P < 0.001). The main reason for complications in both groups was suspected infection (9.77% CVC versus 5.18% PICC). Complication rates due to bacteremia were 2.44% for CVC and 1.15% for PICC. The difference in the incidence of bacteremia per 1000 catheter days was 1.29 (95% confidence interval, -0.89 to 3.90). Overall, costs were lower for PICCs than for CVCs: the difference in mean overall costs was -€559.9 (95% confidence interval, -€919.9 to -€225.4). Uncertainty analysis showed 86.37% of results with lower costs and higher effectiveness for PICC versus CVC. Placement of PICC by VAT compared with CVC for TPN reduces costs and may decrease the rate of bacteremia.
Identifiants
pubmed: 35587883
doi: 10.1097/PTS.0000000000001028
pii: 01209203-202210000-00025
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1109-e1115Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors disclose no conflict of interest.
Références
Walker G, Todd A. Nurse-led PICC insertion: is it cost effective? Br J Nurs . 2013;22(suppl 19):S9–s15.
Wang K, Zhong J, Huang N, et al. Economic evaluation of peripherally inserted central catheter and other venous access devices: a scoping review. J Vasc Access . 2020;21:826–837.
Rotzinger R, Gebauer B, Schnapauff D, et al. Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve. Acta Radiol . 2017;58:1468–1475.
Robinson MK, Mogensen KM, Grudinskas GF, et al. Improved care and reduced costs for patients requiring peripherally inserted central catheters: the role of bedside ultrasound and a dedicated team. JPEN J Parenter Enteral Nutr . 2005;29:374–379.
Hernández PR, López JL, Martín JG, et al. Care and cost-utility indicators for high-flow PICC catheters: a study. Br J Nurs . 2011;20:S22–S27.
Fricke BL, Racadio JM, Duckworth T, et al. Placement of peripherally inserted central catheters without fluoroscopy in children: initial catheter tip position. Radiology . 2005;234:887–892.
Krein SL, Harrod M, Weston LE, et al. Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study. BMJ Qual Saf . 2021;30:628–638.
Chopra V, Ratz D, Kuhn L, et al. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors. J Thromb Haemost . 2014;12:847–854.
Chopra V, Kuhn L, Flanders SA, et al. Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: results of a national survey. J Hosp Med . 2013;8:635–638.
Carr PJ, Higgins NS, Cooke ML, et al. Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database Syst Rev . 2018;3:Cd011429.
Gabriel J, Bravery K, Dougherty L, et al. Vascular access: indications and implications for patient care. Nurs Stand . 2005;19:45–52.
Bayón JC, Gutiérrez A, Galnares L, et al. Análisis económico de los catéteres venosos centrales de inserción periférica (PICC) insertados por personal de enfermería en pacientes oncológicos y hematológicos [press release]. Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación de Tecnologías Sanitarias del País Vasco; 2016.
Chemaly RF, de Parres JB, Rehm SJ, et al. Venous thrombosis associated with peripherally inserted central catheters: a retrospective analysis of the Cleveland Clinic experience. Clin Infect Dis . 2002;34:1179–1183.
Cowl CT, Weinstock JV, Al-Jurf A, et al. Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters. Clin Nutr . 2000;19:237–243.
Periard D, Monney P, Waeber G, et al. Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy. J Thromb Haemost . 2008;6:1281–1288.
Gorski LA. The 2016 infusion therapy standards of practice. Home Healthc Now . 2017;35:10–18.
Moureau N, Chopra V. Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations. Br J Nurs . 2016;25:S15–S24.
Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care . 2015;30:653.e9–653.e17.
Galen B, Baron S, Young S, et al. Reducing peripherally inserted central catheters and midline catheters by training nurses in ultrasound-guided peripheral intravenous catheter placement. BMJ Qual Saf . 2020;29:245–249.
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;36:309–332.
Cortés N, Fuertes MJ, López P, et al. Procedemento de inserción do cateter central de inserción periférica en adultos. Servizo Galego de Saúde . 2019.
Riu M, Chiarello P, Terradas R, et al. Incremental cost of nosocomial bacteremia according to the focus of infection and antibiotic sensitivity of the causative microorganism in a university hospital. Medicine (Baltimore) . 2017;96:e6645.
Allué N, Chiarello P, Bernal E, et al. Impacto económico de los eventos adversos en los hospitales españoles a partir del Conjunto Mínimo Básico de Datos. Gac Sanit . 2014;28:48–54.
Dean AG SK, Soe MM. Open Source Epidemiologic Statistics for Public Health, Version 2013 . Updated June 4, 2013. 3.01. Available at: https://www.openepi.com/Menu/OE_Menu.htm . Accessed June 7, 2021.
Gorski LA, Hadaway L, Hagle ME, et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs . 2021;44(suppl 1):S1–s224.
Thi Anh Thu L, Thi Hong Thoa V, Thi Van Trang D, et al. Cost-effectiveness of a hand hygiene program on health care-associated infections in intensive care patients at a tertiary care hospital in Vietnam. Am J Infect Control . 2015;43:e93–e99.
Ullman AJ, Cooke ML, Mitchell M, et al. Dressings and securement devices for central venous catheters (CVC). Cochrane Database Syst Rev . 2015;2015:Cd010367.
Yamamoto AJ, Solomon JA, Soulen MC, et al. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol . 2002;13:77–81.
Gao Y, Liu Y, Ma X, et al. The incidence and risk factors of peripherally inserted central catheter-related infection among cancer patients. Ther Clin Risk Manag . 2015;11:863–871.
Hanna H, Benjamin R, Chatzinikolaou I, et al. Long-term silicone central venous catheters impregnated with minocycline and rifampin decrease rates of catheter-related bloodstream infection in cancer patients: a prospective randomized clinical trial. J Clin Oncol . 2004;22:3163–3171.
Kagan E, Salgado CD, Banks AL, et al. Peripherally inserted central catheter-associated bloodstream infection: risk factors and the role of antibiotic-impregnated catheters for prevention. Am J Infect Control . 2019;47:191–195.
Walz JM, Ellison RT, Mack DA, et al. The bundle “plus”: the effect of a multidisciplinary team approach to eradicate central line-associated bloodstream infections. Anesth Analg . 2015;120:868–876.
Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med . 2006;355:2725.
Macmillan T, Pennington M, Summers JA, et al. SecurAcath for securing peripherally inserted central catheters: a NICE medical technology guidance. Appl Health Econ Health Policy . 2018;16:779–791.
Pinelli F, Balsorano P, Mura B, et al. Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access . 2021;22:501–508.
Chopra V, Anand S, Hickner A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet . 2013;382:311–325.
Tascini C, Sozio E, Tintori G, et al. Peripherally inserted central catheter as a predominant risk factor for candidemia in critically ill patients in internal medicine wards in Italy. Intensive Care Med . 2015;41:1498–1499.
Rijnders BJ, Peetermans WE, Verwaest C, et al. Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med . 2004;30:1073–1080.
Mishra SB, Misra R, Azim A, et al. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. International J Qual Health Care . 2017;29:63–67.
Wong SW, Gantner D, McGloughlin S, et al. The influence of intensive care unit-acquired central line-associated bloodstream infection on in-hospital mortality: a single-center risk-adjusted analysis. Am J Infect Control . 2016;44:587–592.
Zhou Y, Hu Y, Zhang X, et al. Evaluation on effectiveness and safety of peripherally inserted central catheters technology: an overview of systematic review. Int J Evid Based Healthc . 2016;14:199–200.
Robinson A, Souied O, Bota AB, et al. Optimal vascular access strategies for patients receiving chemotherapy for early-stage breast cancer: a systematic review. Breast Cancer Res Treat . 2018;171:607–620.
Fang S, Yang J, Song L, et al. Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy. Patient Prefer Adherence . 2017;11:1197–1204.