Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study

Supportive Care in Cancer, Sep 2014

Purpose Few prospective follow-up studies evaluating the use of peripherally inserted central catheters (PICCs) to deliver chemotherapy and/or home parenteral nutrition (HPN) have focused exclusively on oncology outpatients. The aim of this prospective study was to assess the reliability and the safety of PICCs over a 5-year use in non-hospitalized cancer patients requiring long-term intravenous therapies. Methods Since June 2008, all adult oncology outpatient candidates for PICC insertion were consecutively enrolled and the incidence of catheter-related complications was investigated. The follow-up continued until the PICC removal. Results Two hundred sixty-nine PICCs in 250 patients (98 % with solid malignancies) were studied, for a total of 55,293 catheter days (median dwell time 184 days, range 15–1,384). All patients received HPN and 71 % received chemotherapy during the study period. The incidence of catheter-related bloodstream infections (CRBSIs) was low (0.05 per 1,000 catheter days), PICC-related symptomatic thrombosis was rare (1.1 %; 0.05 per 1,000 catheter days), and mechanical complications were uncommon (13.1 %; 0.63 per 1,000 catheter days). The overall complication rate was 17.5 % (0.85 per 1,000 catheter days) and PICCs were removed because of complications only in 7 % of cases. The main findings of this study were that, if accurately managed, PICCs can be safely used in cancer patients receiving chemotherapy and/or HPN, recording a low incidence of CRBSI, thrombosis, and mechanical complications; a long catheter life span; and a low probability of catheter removal because of complications. Conclusions Our study suggests that PICCs can be successfully utilized as safe and long-lasting venous access devices in non-hospitalized cancer patients.

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Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study

Paolo Cotogni 0 2 3 Cristina Barbero 0 2 3 Cristina Garrino 0 2 3 Claudia Degiorgis 0 2 3 Baudolino Mussa 0 2 3 Antonella De Francesco 0 2 3 Mauro Pittiruti 0 2 3 0 C. Barbero Department of Cardiovascular and Thoracic Surgery, S. Giovanni Battista Hospital, University of Turin , Turin, Italy 1 ) Anesthesiology and Intensive Care, Unit of Parenteral Nutrition in Oncology, Department of Medicine, S. Giovanni Battista Hospital, University of Turin , Via Giovanni Giolitti 9, 10123 Turin, Italy 2 M. Pittiruti Department of Surgery, Catholic University Hospital , Rome, Italy 3 A. De Francesco Division of Clinical Nutrition, Department of Medicine, S. Giovanni Battista Hospital, University of Turin , Turin, Italy Purpose Few prospective follow-up studies evaluating the use of peripherally inserted central catheters (PICCs) to deliver chemotherapy and/or home parenteral nutrition (HPN) have focused exclusively on oncology outpatients. The aim of this prospective study was to assess the reliability and the safety of PICCs over a 5-year use in non-hospitalized cancer patients requiring long-term intravenous therapies. Methods Since June 2008, all adult oncology outpatient candidates for PICC insertion were consecutively enrolled and the incidence of catheter-related complications was investigated. The follow-up continued until the PICC removal. Results Two hundred sixty-nine PICCs in 250 patients (98 % with solid malignancies) were studied, for a total of 55,293 catheter days (median dwell time 184 days, range 15-1,384). All patients received HPN and 71 % received chemotherapy during the study period. The incidence of catheter-related bloodstream infections (CRBSIs) was low (0.05 per 1,000 catheter days), PICC-related symptomatic thrombosis was rare (1.1 %; 0.05 per 1,000 catheter days), and mechanical complications were uncommon (13.1 %; 0.63 per 1,000 catheter days). The overall complication rate was 17.5 % (0.85 per 1,000 catheter days) and PICCs were removed because of complications only in 7 % of cases. The main findings of this study were that, if accurately managed, PICCs can be safely used in cancer patients receiving chemotherapy and/or HPN, recording a low incidence of CRBSI, thrombosis, and mechanical complications; a long catheter life span; and a low probability of catheter removal because of complications. Conclusions Our study suggests that PICCs can be successfully utilized as safe and long-lasting venous access devices in non-hospitalized cancer patients. - In non-hospitalized cancer patients, the presence of a venous access device (VAD) is important in the anticancer treatment period for chemotherapy [1] or home parenteral nutrition (HPN) [2], as well as in the advanced phase for palliative care [3]. Choosing the appropriate device for the oncology patient should need a proactive vascular access planning; however, the choice of VAD still largely depends on the therapies expected duration or on the clinical experience of the provider [1]. Since the 1970s, peripherally inserted central catheters (PICCs) have been available, but only in the last 20 years has their use dramatically increased in several clinical settings [416]. The use of PICCs has many advantages over other long-term VADs [17, 18]. First is their ease of insertion due to the placement into a peripheral veina safer approachwith the benefit of a central tip location appropriate for any osmolarity and pH infusions (e.g., chemotherapy drugs, hyperosmolar parenteral nutrition (PN) solutions, and longterm antibiotics). PICC placement under ultrasound guidance can be carried out with risks of pneumothorax or hemothorax virtually nonexistent in addition to a low risk of primary malposition [2, 19]. Moreover, their insertion turns out to be less expensive, as they are usually placed by trained nursesin an ambulatory setting or bedsidewithout radiographic or surgical means [6, 17, 20, 21]. Also, patients at high risk of hemorrhage needing a central VAD are eligible for PICC insertion with no risk of local bleeding [1, 2]. Finally, the ease of removal in case of complications offers an adjunctive advantage. Since 2006, a systematic review of 200 published prospective studies of infection associated with the various types of VADs in adults depicted that PICCs (n = 2,813; 98,702 days) were at low risk for catheter-related bloodstream infections (CRBSIs) (0.81.2 per 1,000 catheter days) in outpatients [13]. Nevertheless, some physicians are still concerned about potential risks associated with the use of PICCs in oncology patients requiring prolonged intravenous therapies due to the reported rates of CRBSIs and thrombosis in earlier PICC experiences [22] and the immunocompromised and prothrombotic tendency of the cancer population [23]. Few prospective follow-up studies evaluating the use of PICCs to deliver chemotherapy and/or HPN have focused exclusively on oncology outpatients. The aim of this study was to assess the reliability and the saf (...truncated)


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Paolo Cotogni, Cristina Barbero, Cristina Garrino, Claudia Degiorgis, Baudolino Mussa, Antonella De Francesco, Mauro Pittiruti. Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study, Supportive Care in Cancer, 2015, pp. 403-409, Volume 23, Issue 2, DOI: 10.1007/s00520-014-2387-9