Safety, Feasibility and Cost Of Hematopoietic Stem Cell Transplantation Management By Peripheral Inserted Central Catheter (PICC): A Phase II Prospective Study

Abstract

BackgroundThe management of high dose chemotherapy followed by autologous or allogeneic hemopoietic stem cell transplantation requires an intravenous line for administrations of high-dose chemotherapy, blood and platelet transfusions, antibiotics and parenteral nutrition. In this context a safe central venous access is a basic tool for patients management. The aim of our phase II prospective study is to evaluate feasibility, safety and cost of the use of peripherally inserted central catheters (PICC) for the management of hemopoietic stem cell transplantation. MethodsInclusion criteria included inpatient who needed program of autologous and allogenic hematopoietic stem cell transplantation regardless the underlined hematological disease or white cells and platelets counts. All patients were submitted to a preliminary evaluation of arms vascular anatomy by ultrasonography. All implantation procedures has been done under ultrasound guide with radiographic control after insertion. The PICC cost analysis was performed on the cost of devices, insertion and daily management and compared with a historical cohort of patients with short term central venous catheter (CVC). The study was approved by institutional review board. All patients provided a written informed consent. ResultsFrom March 2007 to July 2013 76 consecutive PICC have been implanted in 74 patients for autologous or allogenic stem cell transplantations. There were 37 male and 37 females. Median age was 55 years, range 22-70. With regard to disease, 11 patients (15%) had Hodgkin Lymphoma, 13 (17.5%) non Hodgkin lymphoma, 9 (12%) acute lymphoblastic leukemia, 35 (47%) multiple myeloma, 4 (5.5%) acute myelogenous leukemia, and 2 (3%) other hematological disease. Fifty-five PICC (72%) have been used for single autologous stem cell transplantation, 10 (13%) for double autologous stem cell transplantation and 11 (15%) for allogenic transplantation. Catheter insertion was successful in all instances. PICC median life was 119 days (1-457) for a total of 10877 days of implanted PICC. At the time of this analysis 4 out of 76 PICC (5%) are still “in situ” and in use and 72 (95%) have been removed. Reason for removal was end of therapy in 58 instances (80.5%), accidental withdrawal in 8 (11%), patient death in 1 (1.5%) and catheter related complication in 5 (7%). Catheter related complications were the following: 2 occlusions, 3 suspected PICC-related sepsis. Only 1 episode of confirmed PICC-related septicemia (0.1/1000 days/PICC) was recorded and S.Aureus was isolated. There were only 2 cases (2.6%) of symptomatic PICC-related thrombotic complications which has requested conservative management. Twenty-five of 76 PICC (33%) were power PICC. No patients presented the need for a additional central venous access. Regarding the economic aspect, the actual daily cost of PICC was 1.98 €/day versus 3.40 €/day of the short term CVC (45% lower). ConclusionsThese data encourage the use of PICC in the autologous and allogenic stem cell transplantation because of insertion easiness, duration of life, cost and low rate complication. Disclosures:Off Label Use: Bendamustine.