Peripherally Inserted Central Catheter Complications in Rural vs. Uban Children Receiving Long-Term Parenteral Antimicrobial Therapy

BACKGROUND: Peripherally inserted central catheters (PICC) are used for treating infections requiring prolonged intravenous antibiotic therapy (IVAT) in children. Given the lack of data on rural PICC use as well as the rural nature of our state, we studied the safety of home PICC use for treating infections in children living in rural settings. METHODS: We identified children <18 years admitted from January 1, 2005 to March 1, 2014 to the University of New Mexico Hospital (UNMH) through analysis of 43 different ICD-9 and CPT codes indicative of PICC placement, with analysis of the medical record to identify patients discharged on IVAT. All data were entered into REDCap and analyzed on Stata. We recorded demographic data, the antibiotic used, the duration/indication for the PICC, and the type/timing of complications. To classify rural vs. urban residence, we used the rural-urban continuum code (RUCC) from U.S. Census data, and the driving time in hours (h) to the nearest level 1,2 or 3 trauma center and UNMH using MapQuest. All patients had either weekly home health or clinic visits, but none utilized an outpatient parenteral antimicrobial therapy (OPAT) clinic. Linear regression models assessed for differences between outcome and response variables. RESULTS: Of 866 subjects with a PICC, 221 were discharged on IVAT. 134 (60.6%) were boys and 87 (39.4%) were girls (mean age 9.8 years). The mean driving time to the nearest level 1, 2, or 3 trauma center was 0.6 hours (range 0.1–3.0 hours), while the mean driving time to UNMH was 1.3 hours (range, 0.1–5.0 hours). PICCs were utilized for a mean of 26.1 days at home. The most common antibiotics used were tobramycin (n = 41) and nafcillin (n = 40). Osteoarticular infections and cystic fibrosis exacerbations were the most common indications for PICC use (68.8%). 47 children (21.3%) experienced complications associated with their PICC at a mean of 24.7 days from insertion, most commonly occlusion (n = 13, 27.7%) or accidental removal (n = 13, 27.7%). 40 PICC’s (18.1%) were removed prematurely due to a complication. No association was found between RUCC’s or driving times to UNMH or the nearest level 1, 2 or 3 trauma center with any of these complications nor with complications overall (P = 0.11 to 0.96). CONCLUSION: Our study demonstrates that home IVAT with a PICC is safe in children in rural locales. DISCLOSURES: All authors: No reported disclosures.