Peripherally Inserted Central Venous Catheters Are Associated With High Complication Rates in Patients With Inflammatory Bowel Disease

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Introduction: Patients with inflammatory bowel disease (IBD) develop perforating complications and utilize total parenteral nutrition (TPN) as a form of treatment. Central venous catheter (CVC) placement is needed to administer TPN and/or antibiotics. The aim of this study was to identify factors associated with complications in IBD patients undergoing CVC placement. Methods: IBD patients that underwent long-term (>14 days) CVC placement from 2004 until 2013 were identified. Clinical information was extracted from a data repository and review of the medical record. CVC were categorized as ports, Hickman catheters (HC), and peripherally inserted central catheters (PICC). Modifications including antiseptic coatings, cuffs, tunneling and antibiotic/anticoagulant flushes were recorded. Development of CVC-related complications was recorded. Results: 93 patients underwent CVC placement. 74% were Caucasian, 70% were women, and 83% had CD. 47, 36, and 17% of CD patients had ileocolonic, ileal, and colonic disease location. 28% had perianal disease and 74% had perforating behavior. 77% of UC patients had pancolitis. 48 underwent HC, 45 underwent PICC, and none had a port. 24 (26%) developed a complication, including 20 line infections, 3 thrombotic events, and 1 septic thrombosis. 2 patients died. 96% of patients with complications underwent CVC placement to receive TPN. 19 (31%) patients undergoing PICC placement had a complication compared to 5 (19%) patients undergoing HC placement (p < 0.18). Modifications to CVC placement did not decrease the rate of CVC-complications. Patients with an abscess or treated with antibiotics at admission and those that developed post-operative infections were more likely to develop complications (p < 0.05). Methotrexate (MTX) was associated with complications (p < 0.05); however the number of patients treated with MTX was small (n=6). 13 (72%) patients with a history of MRSA, VRE, or CRE developed complications compared to 18% of patients without resistant bacteria (p=0.03). A history of prior CVC-related infection was associated with complications (56 vs. 19%, p=0.001). Patients with peripheral vascular disease and connective tissue diseases were more likely to develop complications (p=0.02). Conclusion: Providers should advocate strongly for HC placement if considering long term CVC use in IBD patients, especially if concurrent infection, prior CVC-related infection, or a history of resistant organisms is present.