Improving Outcomes, Improving Throughput, Mythbusting, Pediatrics

The Bell Tolls for the PICC

In today’s fight against “this patient needs IV antibiotics,” this study looks at 2060 children hospitalized for osteomyelitis from January 1, 2009, through December 31, 2012, at 36 participating children’s hospitals. 1055 received a PICC line at discharge for IV antibiotics, 1005 received oral antibiotics only at time of discharge. Among the children in the PICC group, 158 (15.0%) had a PICC complication, with 5.9% of all PICC patients requiring a rehospitalization – rates much worse than the PO antibiotic group.

Sure, I guess PICCs are great for patients allergic to many oral antibiotics, but they represent a select group. There is evidence that early oral antibiotics are better for acute cholangitis and bacteremia, and early conversion to PO antibiotics reduces length of stay without causing harm. Then there is the dogma of needing IV antibiotics for the pregnant pyelonephritis patient and orbital cellulitis, not to mention the fact that even a single dose of IV antibiotics is associated with more AAD.

When you take into account the amount of time off work for the patient and family, the associated cost of an infusion center and visiting nursing services, and consider that the evidence generally guides away from the usage of IV antibiotics when PO options are available, its time to toll the bell for routine placement of PICCs.

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