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Repurposing the power injectable PICC as tunnelled central venous access

"In this pilot study, we have evaluated the off-label use of peripherally inserted central catheters as a tunnelled supraclavicular centrally inserted central catheter" Low et al (2020).

Abstract:

Objectives: Usual short- to mid-term vascular accesses for oncologic patients include the peripherally inserted central catheter and non-tunnelled centrally inserted central catheters, inserted in the supraclavicular or infraclavicular area. Peripherally inserted central catheters can be restrictive in active patients; supraclavicular non-tunnelled centrally inserted central catheters are not ideal in terms of exit site location and cosmesis, while infraclavicular non-tunnelled centrally inserted central catheters may be associated with puncture-related complications. In this pilot study, we have evaluated the off-label use of peripherally inserted central catheters as a tunnelled supraclavicular centrally inserted central catheter.

Methods: Ten patients were recruited for this prospective study. A non-cuffed, power injectable peripherally inserted central catheter was inserted via a short subcutaneous tunnel into the internal jugular vein using the peel-away sheath and introducer as a tunneller. Puncture wounds were closed with tissue glue. Patients were followed up for comfort scores, dwell time and complications.

Results: The median dwell time was 94 days (mean of 113 days). One catheter was removed due to systemic fungemia, resulting in an acceptable complication rate of 0.97 per 1000 catheter days.Mean patient-reported comfort scores was 16 (out of 20). Pressurised injections for computer tomography imaging were performed in five patients without complications.

Conclusion: Despite limited numbers, this method appears to be safe and well accepted with low complication rates. This modified vascular access is low profile, easily concealed, readily removable and compatible with pressure injector and uses a commonly found catheter in a modified fashion. Larger prospective trials will be needed to ascertain if it can be a standard of care for oncological patients.

Reference:

Low XZ, Tay KH, Leong S, et al. Repurposing the power injectable peripherally inserted central catheter as a tunnelled, non-cuffed, centrally inserted central venous catheter in oncological patients for short- to mid-term vascular access: A pilot study . J Vasc Access. 2020;1129729820943449. doi:10.1177/1129729820943449