Peripherally Inserted Central Catheter for Use in Home Parenteral Nutrition

Abstract

Peripherally inserted central catheters (PICCs) are a relatively new device for home parenteral nutrition (HPN). Usually, tunneled central catheters such as the Hickman catheter are used for this purpose. However, severe complications (eg, pneumothorax) have been reported in association with the insertion of the central catheter. In contrast, PICCs may offer some advantages due to the peripheral insertion. There are only few studies on the use of PICCs for HPN. A retrospective study (2008-2012) was performed in our Center for Nutrition and Bowel Disease. Patients receiving parenteral nutrition through PICCs were identified, their files examined, and indication, dwell time, cause of removal, and complications recorded. Fifty-six patients (aged 28-81 years) had a total of 94 lines. Total catheter days were 9859. Mean catheter days per patient were 179.1, and mean dwell time of each line was 104.9 days (longest, 572 days). There were no major complications in relation to the insertion of the catheters. The catheters were removed due to catheter-related sepsis, mechanical reasons, and thrombotic complications in 1.7, 2.1, and 0.2 per 1000 catheter days, respectively. This study demonstrates that PICCs are appropriate for use in HPN for at least 3-4 months (a period that sometimes unexpectedly becomes long term). The complications equal those reported for tunneled central catheters. We conclude that PICCs are a relevant alternative to patients receiving HPN, especially if they cannot handle a central line. At present, the choice of catheter must be determined on an individual basis.