Weaknesses of this chart review include its retrospective nature and also the unequal distribution of gestational age, postnatal age, catheter days, tip location, and insertion site (central or peripheral) between different PICC groups (Tables 2 and 4). We addressed this unequal distribution using multivariate regression. Unadjusted and adjusted odds ratios were not statistically different when we compared the complications of the 2.6-Fr double-lumen PICC group with the 1.9-Fr lumen PICC group. Incidental finding in this study was CLABSI rate: with 1.5/1000 catheter days in the 2.6-Fr double-lumen PICC group compared with 0/1000 catheter days in the 1.9-Fr PICC group. Lower or no CLABSI rate in the 1.9-Fr group may be due to selection bias, which might have occurred during our matching process. This CLABSI prevalence in the 2.6-Fr double-lumen group of 1.5/1000 catheter days is comparable to the CLABSI rate in other studies, with single-lumen PICCs 1.66 to 2.01/1000 catheter days.22,23 The higher rate of CLABSI in the 2.6-Fr PICC group could also be explained by dwell time of the catheters or the presence of multiple access ports multiplying risk. In our study, dwell time of 2.6-Fr PICCs double-lumen is more than 2 weeks (21 days, IQR 11-30 days) compared to less than 2 weeks in the 1.9-Fr PICC group (12 days, IQR 7-23 days; P < .05) (Table 2). Alternatively, the CLABSI rate in the 2.6-Fr PICC group in our study could have been due to entering the lines for blood withdrawals and blood product transfusion. We did not have the data regarding how many times the infected lines were accessed compared with noninfected lines for blood draws or blood sampling. The overall complications and noninfectious complications were not different between these 2 groups of PICCs (Table 5). Another serendipitous finding was neck veins were used more in 2.6-Fr PICCs compared with 1.9-Fr PICCs, and we speculate that this was due to site availability in a particular patient. We did not examine catheter migration or difficulty with catheter removal as possible complications. The latter did not occur in our sample, but migration was occasionally noted in all groups but was not measured. In addition, the success rate and the number of needle sticks required were not compared and need to be addressed in future studies.
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