Role of Peripherally Inserted Central Catheters (PICCs) in home parenteral nutrition

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Intravenous literature: Botella-Carretero, J.I., Carrero, C., Guerra, E., Valbuena, B., Arrieta, F., Calañas, A., Zamarrón, I., Balsa, J.A. and Vázquez, C. (2012) Role of Peripherally Inserted Central Catheters in Home Parenteral Nutrition: A 5-Year Prospective Study. Journal of Parenteral and Enteral Nutrition. Aug 16. [Epub ahead of print].

Abstract:

BACKGROUND: Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being preferred for its administration. Peripherally inserted central catheters (PICCs) are not currently recommended for long-term HPN, although evidence to support this statement is scarce. The authors aimed to evaluate the outcomes of HPN, focusing on CVC-related complications. Materials and

METHODS: All patients attended at the authors’ center for HPN from 2007-2011 were prospectively included. HPN composition aimed at 20-35 kcal/kg/d, 3-6 g/kg/d of glucose, 1.0 g/kg/d of amino acids, and <1 g/kg/d of lipids. HPN was infused in an intermittent schedule, mostly at night. Catheter-related bloodstream infections (CRBSIs) were confirmed with positive semi-quantitative or quantitative culture of the catheter or simultaneous differential blood cultures drawn through the CVC and peripheral vein.

RESULTS: Seventy-two patients received HPN, with 79 implanted CVCs (48 PICCs, 10 Hickman, and 21 ports). Mean catheter-days were 129.1 for PICCs, 98.5 for Hickman, and 67.7 for ports (P = .685). When analyzing CRBSIs, ports had 44, Hickman had 20, and PICC had 0 episodes per 1000 catheter-days (P = .078). Only PICCs showed less incidence of CRBSIs vs ports (P = .043). Multivariate logistic regression, correcting by catheter-days, patients’ age and sex, underlying disease, and type of catheter, showed that only catheter-days (P = .031) was a predictor for CRBSIs (P = .007, Nagelkerke R= = 0.246).

CONCLUSION: PICCs are similar in terms of catheter-related complications to other CVCs for the administration of HPN, especially for oncology patients with HPN lasting <6 months.

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