A Comparison of Antibiotic Serum Concentrations Drawn Simultaneously from Peripherally Inserted Central Catheters and Peripheral Veins in Children with Respiratory Infection
Section snippets
Background and Significance
Antibiotic therapy is regularly used to treat children with serious bacterial respiratory infection, especially those with an underlying chronic condition such as cystic fibrosis (CF) (Flume et al., 2009). Two of the more commonly prescribed medications are vancomycin and tobramycin, both can be given IV and require serum level monitoring. Vancomycin is a glycopeptide and is used to treat infections caused by gram-positive bacteria, specifically methicillin-resistant Staphylococcus aureus
Purpose
The purpose of this study was to compare serum concentrations of IV vancomycin and IV tobramycin drawn from a PICC with serum concentrations drawn using peripheral venipuncture. The primary research question of this study was: 1. Are the serum concentrations of antibiotics drawn from PICC and venipuncture equivalent? The secondary research question was: 2. Does increasing the number of medication doses through the same PICC line impact the equivalence of the serum concentrations?
Setting and Sample
This prospective, comparative study took place on two inpatient medical units in a free-standing tertiary children's hospital in the northeastern part of the United States. Serum samples were collected August 2010 through June 2012 from a convenience sample of 90 subjects with each subject serving as his or her own control.
Patients were eligible to participate if (1) aged 1 month to 21 years, (2) admitted to one of two inpatient medicine units with a diagnosis of respiratory infection, (3) had a
Data Analysis
Data were entered by study personnel into a password-protected SPSS database (version 18.0, SPSS INC., Chicago, IL). Descriptive statistics were used to analyze demographic data such as age, diagnosis, gender, catheter insertion date, and size and medication information (Table 3). A paired t-test was used to compare the antibiotic concentration levels for the PICC and venipuncture blood samples (Figure 1 and Table 4, Table 5).
Sample Characteristics
The majority of study subjects were female (53%), non-Hispanic (84%), White (80%) and between ages 9.5 months and 23 years (Table 3). The majority of PICC lines were manufactured by Bard® (67%), 14% by Cook® and in 18% of participants the catheter manufacturer was not documented. The majority of the subjects (n = 82) had cystic fibrosis and were admitted for a pulmonary exacerbation and course of IV antibiotic treatment. The remaining 8 subjects were being treated for pneumonia or pleural
Discussion
In general, the evidence in the literature to support or refute obtaining tobramycin and vancomycin levels from PICCs in pediatric patients with respiratory illness is inconsistent (Wilson & Jamerson, 2012). Although our study findings demonstrated a statistically significant difference for combined peak and trough antibiotic levels drawn from a PICC line versus a peripheral venipuncture the difference in values was small enough to warrant no clinical significance or changes in therapy. Using
Conclusions
Although statistically significant, the findings from this study suggest that with standardized flush and discard procedures, IV vancomycin and IV tobramycin levels drawn from PICC lines yield clinically useful results when compared to samples drawn from peripheral venipuncture, thus decreasing the need for painful venipuncture in children. The Pediatric Bill of Rights, supported by various pediatric hospitals in the U.S. and health care organizations, states children have the right to be
Acknowledgments
Jayne Rogers, Ellen McGrath, Cindy Williams, Gregory Sawicki, Henry Dorkin, and all of the inpatient nurses who supported this project. Financial grant received from the Inpatient Medicine and Harvard Clinical and Translational Research.
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