Abstract:
Background: Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this prospective, cohort, 7-year study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients on home parenteral nutrition (HPN).
Methods: We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs.
Results: We evaluated 854 central VADs [401 PICCs, 137 non-tunneled centrally inserted central catheters (CICCs), 118 tunneled-cuffed CICCs, and 198 ports] in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections (CRBSIs) was low (0.29/1000), particularly for PICCs (0.08/1000; P <0.001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P <0.019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were similar to tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < 0.001); there was no difference in total complications between PICCs and ports.
Conclusions: PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.
Reference:
Cotogni, P., Mussa, B., Degiorgis, C., De Francesco, A. and Pittiruti, M. (2020) Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter Days. JPEN. Journal of Parenteral and Enteral Nutrition. June 8th. https://doi.org/10.1002/jpen.1939. (epub ahead of print).