Should you pick the PICC? Prolonged use of peripherally inserted central venous catheters in children with intestinal failure

Abstract

PurposeProlonged central vascular access is a source of significant morbidity in children with intestinal failure (IF). In an effort to decrease morbidity, our multidisciplinary IF team has primarily used peripherally inserted central catheters (PICCs) for these patients. We compared outcomes of PICCs to Broviacs®. MethodsA review of children with IF (2006–2018) at an academic children's hospital was conducted. Inclusion criteria: total parenteral nutrition duration >42 days or small bowel length < 25% of total for gestational age. Complications/1000 catheter days were extracted, and a Poisson model was used to compare complications between PICCs and Broviacs®. ResultsThirty-seven patients with IF were included, accounting for 19,452 catheter days. There were 209 PICCs (1.2–4F) and 39 Broviacs® (2.7–7F). The median duration of overall PICC access/patient was 166 days (range: 35 days–8 years). Incidences of central line associated blood stream infection and venous thrombosis were 3.95 and 0.55 per 1000 catheter days, respectively. There were no significant differences in complication rates per line per catheter day between PICCs and Broviacs® on multivariate analysis. Broviacs® showed a trend towards increased of catheter-related hospital admissions when compared to PICCs. ConclusionsPICCs in children with intestinal failure have similar complication rates to Broviacs® but may reduce catheter-related hospital admissions. Use of tunneled PICCs and increasing experience with this vascular access method may allow it to realize its potential advantages. Level of evidenceRetrospective study, level III.