Skip to main content Accessibility help

Medically Attended Catheter Complications Are Common in Patients With Outpatient Central Venous Catheters

  • Steven S. Spires (a1), Peter F. Rebeiro (a1) (a2), Mickie Miller (a3), Katie Koss (a3), Patty W. Wright (a1) and Thomas R. Talbot (a1) (a4)...



Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line–associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system.


Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed.


A CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort.


Medically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs.

Infect Control Hosp Epidemiol 2018;39:439–444


Corresponding author

Address correspondence to Steven S. Spires, MD, Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, A2200 MCN, 1161 21st Ave South, Nashville, TN 37232-2605 (


Hide All

PREVIOUS PRESENTATION. A portion of the findings of this study was presented as an oral abstract presentation at the Society for Healthcare Epidemiology of America Spring Conference on May 15, 2015, in Orlando, Florida.



Hide All
1. Chary, A, Tice, AD, Martinelli, LP, Liedtke, LA, Plantenga, MS, Strausbaugh, LJ. Experience of infectious diseases consultants with outpatient parenteral antimicrobial therapy: results of an emerging infections network survey. Clin Infect Dis 2006;43:12901295.
2. Rinke, ML, Milstone, AM, Chen, AR, et al. Ambulatory pediatric oncology CLABSIs: epidemiology and risk factors. Pediatr Blood Cancer 2013;60:18821889.
3. Walshe, LJ, Malak, SF, Eagan, J, Sepkowitz, KA. Complication rates among cancer patients with peripherally inserted central catheters. J Clin Oncol 2002;20:32763281.
4. Tokars, JI, Cookson, ST, McArthur, MA, Boyer, CL, McGeer, AJ, Jarvis, WR. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy. Ann Intern Med 1999;131:340347.
5. Grau, D, Clarivet, B, Lotthe, A, Bommart, S, Parer, S. Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control 2017;6:18.
6. Vidal, V, Muller, C, Jacquier, A, et al. Prospective evaluation of PICC line related complications [in French]. J Radiologie 2008;89:495498.
7. Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:11591171.
8. Keller, SC, Williams, D, Gavgani, M, et al. Environmental exposures and the risk of central venous catheter complications and readmissions in home infusion therapy patients. Infect Control Hosp Epidemiol 2017;38:6875.
9. Rinke, ML, Bundy, DG, Chen, AR, et al. Central line maintenance bundles and CLABSIs in ambulatory oncology patients. Pediatrics 2013;132:e1403e1412.
10. Kelly, MS, Conway, M, Wirth, KE, Potter-Bynoe, G, Billett, AL, Sandora, TJ. Microbiology and risk factors for central line-associated bloodstream infections among pediatric oncology outpatients: a single institution experience of 41 cases. J Pediatr Hematol/Oncol 2013;35:e71e76.
11. Harrell, FE. Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York: Springer; 2001.
12. US Department of Health and Human Services. National Action Plan to Improve Health Literacy. Washington, DC: US Department of Health and Human Services; 2010.
13. Garibaldi, RA, Burke, JP, Dickman, ML, Smith, CB. Factors predisposing to bacteriuria during indwelling urethral catheterization. New Engl J Med 1974;291:215219.
14. Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Chenoweth, C, Krein, S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 2014;127:319328.
15. Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Lee, A, Krein, S. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors. J Thromb Haemostas 2014;12:847854.
16. Santarpia, L, Buonomo, A, Pagano, MC, et al. Central venous catheter related bloodstream infections in adult patients on home parenteral nutrition: prevalence, predictive factors, therapeutic outcome. Clin Nutr (Edinburgh, Scotland) 2016;35:13941398.
17. Allen, RC, Holdsworth, MT, Johnson, CA, et al. Risk determinants for catheter-associated blood stream infections in children and young adults with cancer. Pediatr Blood Cancer 2008;51:5358.
18. Kullberg, BJ, Arendrup, MC. Invasive candidiasis. New Engl J Med 2015;373:14451456.
19. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. New Engl J Med 2014;370:11981208.
20. Chesshyre, E, Goff, Z, Bowen, A, Carapetis, J. The prevention, diagnosis and management of central venous line infections in children. J Infect 2015;71(Suppl 1):S59S75.
21. Marschall, J, Mermel, LA, Fakih, M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:753771.
22. Tomar, S, Lodha, R, Das, B, Sood, S, Kapil, A. Risk factors for central line associated bloodstream infections. Indian Pediatr 2016;53:790792.
23. Buchman, AL, Opilla, M, Kwasny, M, Diamantidis, TG, Okamoto, R. Risk factors for the development of catheter-related bloodstream infections in patients receiving home parenteral nutrition. JPEN 2014;38:744749.
24. Freeman, J, Goldmann, DA, Smith, NE, Sidebottom, DG, Epstein, MF, Platt, R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. New Engl J Med 1990;323:301308.


Altmetric attention score

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