Peripherally Inserted Central Catheters Days Research Articles

Peripherally Inserted Central Catheters-associated blood stream infections-occurrence, risk factors, and pathogens, a single center study.

Peripherally inserted central catheters (PICCs) are central venous catheters inserted peripherally but terminate in great vessels. PICCs are widely used for patients requiring long-term intravenous therapy in both in-patient and out-patient settings. This study was carried out to understand PICC-related complications, specifically infections and causal pathogens, in a tertiary care hospital in Kerala, South India. A retrospective analysis of PICC insertions and follow-up during a 9years period to look at patient demographics and infections related to PICC was carried out. The overall PICC-related complication rate is 28.1% (4.98 per 1000 PICC days). Commonest complication was thrombosis followed by infection, either PICC-associated bloodstream infection (PABSI) or local infection (LI). PABSI noted in this study was 1.34 per 1000 catheter days. The majority (85%) of PABSI were due to Gram-negative rods. The average duration of PICC days for occurrence of PABSI was 14days and the majority occurred in in-patients. Thrombosis and infection were the commonest PICC-related complications. PABSI rate was comparable to that of previous studies.

SPONTANEOUS CATHETER MALPOSITIONING: A CASE REPORT

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Peripherally inserted central catheter (PICC) usage has increased significantly since introduction in the late 1970s. Growing bodies of evidence demonstrate the safety and efficacy of PICCs for treatment regimens up to 6 months in the outpatient setting, but PICCs can have complications. We described a patient with spontaneous repositioning of his PICC line tip with subsequent resolution. CASE PRESENTATION: A 39-year old man with an extensive past medical history presented to a referring hospital for sudden onset, severe abdominal pain, and new associated shortness of breath. On hospital day (HD) 3, a PICC was placed in his right upper extremity with the tip overlying the cavoatrial junction. A CT chest on HD8 demonstrated a change: the tip of the PICC had reversed course and flipped from the SVC into the ipsilateral internal jugular vein. The PICC flushed appropriately and drew briskly. Our medical center’s dedicated peripheral access team power-flushed the catheter a total of three times. The patient reported that he heard the first flush in his right ear, but did not hear the subsequent second nor third flushes. A repeat chest XR demonstrated an interval flip in the direction of the PICC with the tip appropriately at the junction of the right brachiocephalic vein and the superior vena cava. This PICC flipped once more before removal before discharge. DISCUSSION: Although studies have been performed examining rates of inappropriate positioning after initial PICC placement, limited data exist regarding rates of spontaneous malpositioning of PICC tips. Subsequently, no societal guidelines exist for PICC placement monitoring in a patient receiving extended therapy intravenous medication delivery. Our medical center’s policy states that all forms of existing central access in the upper extremity or trunk are verified using chest XR or other imaging upon patient presentation to the emergency department or admission to a hospital before usage. When PICC tips are noted to be inappropriately positioned, there exists data to support both a trial of observation for spontaneous repositioning (especially if the catheter edge is in the ipsilateral internal jugular vein or contralateral subclavian vein) and immediate intervention or manual repositioning. CONCLUSIONS: Given that our patient’s PICC spontaneously repositioned twice during 13 hospital days and the morbidity that inappropriately positioned peripheral catheters can cause, it may be reasonable to obtain a routine chest XR to verify PICC positioning every 1 to 2 weeks for both hospitalized and ambulatory care patients. When PICCs spontaneously malposition, we support decision making on a case-by-case basis, depending on the patient’s acuity, associated symptoms, the ability of the catheter to draw/flush appropriately, availability of other intravenous access, and remaining anticipated required length of central access. Reference #1: King MM, Rasnake MS, Rodriguez RG, Riley NJ, Stamm JA. Peripherally inserted central venous catheter–associated thrombosis: retrospective analysis of clinical risk factors in adult patients. South Med J. 2006;99(10):1073–1077 Reference #2: Chen W, He L, Yue L, Park M, Deng H.: Spontaneous correction of misplaced peripherally inserted central catheters. Int J Cardiovasc Imaging. 2018 Jul;34(7):1005-1008. doi: 10.1007/s10554-018-1321-5. Reference #3: Campagna S, Et Al.: A retrospective study of the safety of over 100,000 peripherally-inserted central catheters days for parenteral supportive treatments. Res Nurs Health. 2019 Jun;42(3):198-204. DISCLOSURES: No relevant relationships by Christian Ghattas, source=Web Response No relevant relationships by Divyesh Mehta, source=Web Response No relevant relationships by Virgil Secasanu, source=Web Response

Infection and Thrombotic Complications in Peripherally Inserted Central Catheters (PICCs) in Cancer Patients at Healthcare Global Hospital, Bangalore

Introduction: Peripherally inserted central catheter (PICC) is a form of vascular access device (VAD) that can be used for a prolonged period of time in cancer patients for diverse indications. Despite the many advantages, catheter related complications are common.
 Objectives: The objective of this study was to evaluate infection and thrombotic complications of PICCs in cancer patients.
 Methodology: We conducted a prospective longitudinal study, over a duration of thirty months from June 2015 to December 2017 in the Department of Haematology and Medical Oncology at our tertiary care, cancer hospital to assess, analyze and compare the infection and thrombotic complications in cancer patients with a PICC line. All patients with cancer who met the inclusion criteria were enrolled and were followed up until catheter removal. The basic information regarding PICCs insertion, weekly care and removal was maintained. The data were analyzed and compared to identify catheter related complications
 Result: Four hundred and sixty-one PICCs were monitored for a total of 57,438 catheter-days (mean of 124 days i.e. 4.15 months, range : 1 to 434 days). Out of these 461 PICCs, 29 (6.29%) had both infection and thrombotic complications, as a result of which 22 were removed in 57,438 catheter days. (ie catheter removal rate was 0.38 per 1000 PICC days). Infection complications were found more with hematological malignancies while thrombotic complication were predominant in solid tumours.
 Conclusion: Infection complications were more common in hematological cancer patients than solid cancers where thrombotic complications were more common.

Peripherally inserted central catheters in allogeneic hematopoietic stem cell transplant recipients.

Central venous catheters (CVC) are essential for the management of patients with hematologic malignancies, facilitating chemotherapy infusion, antibiotics, parenteral nutrition, blood products, and blood samples collection. In this population, peripherally inserted central catheters (PICC) seem to be associated with lower complications, compared with conventional percutaneously inserted devices (CICC). Data on the PICC in allogeneic hematopoietic stem cell recipients (allo-HSCT) are limited. We have prospectively evaluated the safety and efficacy of 100 polyurethanes or silicone PICC, inserted into 100 adult allo-HSCT recipients, at the Hematology of Sapienza University of Rome (Italy), between October 2012 and August 2017. The median duration of PICC placement was 117days. Overall, 68% of patients maintained the device for the entire transplant procedure and PICC were removed after day 100 from allo-HSCT; of these, 44% did not experienced any PICC-related complications. Catheter-related bloodstream infections (CRBSI) occurred in 32% of patients (2.5/1000 PICC days), associated with thrombosis in 8 cases. CRBSI were observed in 42% of patients with polyurethane and 20% with silicone PICC (p = 0.02). Catheter-related thrombosis occurred in 9% of patients, never requiring anticipated PICC removal. Mechanical complications occurred in 15% of cases (1.2/1000 PICC days). On the whole, adverse events were manageable and did not affect transplant outcome. No deaths related to PICC-complications were observed. PICC are a safe and reliable long-term venous access in allo-HSCT recipients.

A retrospective study of the safety of over 100,000 peripherally-inserted central catheters days for parenteral supportive treatments.

The type of central vascular access device providers chosen for providing parenteral supportive treatments has evolved over the past years, going from routinely used centrally inserted catheters to a more recent trend of peripherally-inserted central catheters (PICCs) when expected treatment duration is less than 6 months. This multicenter retrospective study aimed to provide a comprehensive assessment of the safety of PICCs in administering parenteral supportive treatments. All adult inpatients and outpatients who had a PICC inserted for the administration of parenteral supportive treatments (i.e., parenteral nutrition, intravenous fluids, blood products, or antibiotics) between September 2007 and December 2014 in four public Italian hospitals were included. The primary outcome was PICC removal because of an adverse event (AE, defined as occlusion, exit-site infection, or symptomatic thrombosis). Among the 1,250 included patients, 178 PICC-related removals because of AEs (14.2%; 1.62 AEs per 1,000 PICC days) were reported. Rates of PICC removal because of occlusion, exit-site infection, and symptomatic thrombosis were 1.08, 0.32, and 0.23 per 1,000 PICC days, respectively. The median dwell-time between PICC insertion and its removal because of an AE was 67 days (interquartile range 28-180 days). Risk of PICC removal due to AE was higher with open-system PICCs [hazard ratio = 2.75, 95% confidence interval 1.52-4.96]. In this study, we found preliminary evidence that PICCs can be safely used to administer parenteral supportive treatments lasting up to 6 months. PICCs may be a relevant alternative to centrally inserted catheters for medium-term parenteral supportive treatments.

Peripherally InSerted CEntral catheter dressing and securement in patients with cancer: the PISCES trial. Protocol for a 2x2 factorial, superiority randomised controlled trial

IntroductionAround 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective...

Peripherally Inserted Central Catheter Experience in Long-Term Home Parenteral Nutrition Patients

Parenteral nutrition is administered through a central venous catheter(CVC). Peripherally inserted central catheters (PICC) are appropriate for home parenteral nutrition (HPN). The objective of this study was to examine a group of HPN patients with a PICC in place for more than six months, and the complications associated with PICC removal. Medical records from one home infusion pharmacy were retrospectively reviewed for PICC characteristics and complications leading to removal. Nineteen adult HPN patients had 26 PICC placements. Total PICC days were 22,262 with a mean of 856 (265-2500) days. Seven PICCs were in place for 3 to greater than 5 years. The overall complication rate was 0.58/1000 CVC days. Catheter related bloodstream infection (CRBSI) was the main cause of PICC removal. There was no evidence of symptomatic thrombosis. Patients experienced no infusion related complications. The PICCs were 88% polyurethane, 65% double lumen, and 54% were 5 Fr. No patient received alcohol or antibiotic lock therapy, and 8 patients had successful alteplase administered at least one time. All patients needed caregiver assistance for site care and dressing changes, but were independent in HPN infusion and flushing. This group of patients demonstrated that PICCs are a viable option HPN administration. The PICC overall complication rate was very low, and the most frequent complication leading to removal was CRBSI. The infection rate of 0.36/1000 CVC days is considered very low in an HPN population. This is the only HPN infusion study to date reporting 7 PICCs lasting 3 or more years, with 2 lasting greater than 5 years without complications resulting in removal. Patients received their prescribed therapy reliably and without interruption with this device. Larger studies are needed to confirm the efficacy of maintaining a PICC for very long-term HPN administration.

Safety, efficacy, and patient-perceived satisfaction of peripherally inserted central catheters in terminally ill cancer patients: a prospective multicenter observational study.

The purpose of this study was to investigate the safety, efficacy, and subjective satisfaction of peripherally inserted central catheters (PICCs) in terminally ill cancer patients. All PICCs were inserted by an interventional radiologist with radiological guidance. We monitored the occurrence of PICC-related complication and evaluated the patient-perceived satisfaction for PICC using semi-structured questionnaire. A total of 36 terminally ill cancer patients underwent PICC. Three patients had 2 PICC insertions; hence, finally 39 episodes during 829 PICC days were analyzed. All procedures were completed without any procedure-related complication. The median catheter life span was 19.0days (95% CI, 14.1-23.9). Thirty-four cases maintained the PICC until the intended time, while the other 5 cases (12.8%; 6.1/1000 PICC days) were premature PICC removals. Totally 10 complications (25.6%; 12.3/1000 PICC days) were reported including premature removals (n=5), trivial bleedings (n=3), and thrombophlebitis (n=2). Patients reported that the procedure was not distressing (42%), a little distressing (36%), or distressing (21%). Of 30 patients who had preserved cognitive function at fifth day, most patients (n=25, 83%) reported more comfort although the other 5 patients reported no change (n=3) or less comfort (n=2). PICCs were safely inserted and showed favorable maintenance rate with acceptable complications. Additionally, most of the patients felt that parenteral access became much comfortable after PICC insertion. When considering the characteristics of terminally ill cancer patients, poor general condition and a limited period of survival, PICC could be a safe and effective method for intravenous access.

A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study.

Use of peripherally inserted central catheters (PICCs) has markedly increased during the last decade. However, there are few studies on use of PICCs in patients with haematological malignancies (HM) receiving intensive chemotherapy. Preliminary data suggest a higher rate of PICC-related complications in these high-risk patients. This prospective observational single-centre study aimed to investigate PICC-related complications after implementation of a multidisciplinary approach to PICC care and compared it with previous literature. A total of 44 PICCs were inserted in 36 patients (27.3%, thrombocytopenia <50 × 10(9)/L at insertion) over 5045 PICC days (median duration, 114.5 days). No major insertion-related complications were observed. Major late complications were obstruction in 13.6% (1.19/1000 PICC days) of patients, catheter-related bloodstream infection in 6.8% (0.59/1000 PICC days), and catheter-related thrombosis in 4.5% (0.39/1000 PICC days). Premature PICC removal occurred in 34% (2.97/1000 PICC days) of patients. The overall rate of potentially major dangerous complications was particularly low (11.36%, 0.99/1000 PICC days) compared with previous studies. This study highlights the utility of a multidisciplinary approach for PICC care in adults with HM receiving intensive chemotherapy. We provide further data to support use of PICCs in such patient populations.

Catheter-associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters (PICC).

The use of peripherally inserted central catheters (PICC) as an alternative to other central venous access devices (CVAD) is becoming very frequent in cancer patients. To evaluate the impact of complications associated to these devices in patients with hematologic malignancies, we revised the catheter-related bloodstream infections (CRBSI) and the catheter-related thrombotic complications (CRTC) observed at our institute between January 2009 and December 2012. A total of 612 PICCs were inserted into 483 patients at diagnosis or in subsequent phases of their hematologic disease. PICCs were successfully inserted in all cases. The median duration of in situ PICC placement was 101 days (interquartile range, 48-184 days). A CRBSI occurred in 47 cases (7.7 %), with a rate of 0.59 per 1000 PICC days. A CRTC was recorded in 16 cases (2.6 %), with a rate of 0.20 per 1000 PICC days. No serious complication was associated to these events. Cox regression analyses of variables associated to CRBSIs and to CRTCs showed that only the type of disease (acute leukemia compared to other diseases) was significantly associated to a higher incidence of CRBSIs, while no feature was predictive for a higher risk of CRTCs. PICCs represent a useful and safe alternative to conventional CVAD for the management of patients with hematologic malignancies.

Peripherally Inserted Central Catheters (PICCs) Can Be Successfully Utilized in Haematological Patients: Efficacy of an Educational Program.

AbstractAbstract 3161 Purpose:Patients with haematological disorders frequently require the insertion of medium or long-term central venous catheters (CVCs) for stem-cell transplantation, the administration of chemotherapy, or transfusions. Although peripherally inserted central catheters (PICCs) have been in use for many years, little data exist on their use in patients receiving intensive chemotherapy and blood progenitor cell transplantation. Methods:Evidence-based interventions were implemented in our department from November 2009 to July 2012, and include: 1.An high level nurse education program for correct practices and prevention of catheter-associated complications. was developed for PICC nursing team; 2) The use of ultrasound guide for the insertion of the tip of PICCs, thanks to a special operator training; 3) Bedside placement and confirmed PICC tip placement by chest radiography after removal of the guidewire and before the securing of the catheter; 4) Maintenance of maximum sterile barrier precautions during PICC insertion and aftercare; 5) chlorhexidine preparation, replace 10% povidone iodine for skin antisepsis; 6) adoption of PICC patient nurse archive, including the information of weekly PICC line review at our department for each patient. Aim:Here, we carried out a clinical prospective investigation to determine the efficacy of these interventions in reducing the rate of PICC-related complications (thrombotic events, exit site infection and other complications requiring early removal of PICCs); the studied population included hematology patients receiving intensive chemotherapy compared to allogeneic/autologous stem cell transplant recipients. Results:Three hundred sixty-four (364) PICCs were in place in 299 patients for a total of 41.111 PICC days ( range, 1–482 days; mean 112,94 days); 292 were inserted in patients receiving conventional chemotherapies, and 72 in patients undergoing allogeneic or autologous hematopoietic stem cell transplantation (SCT). Sixty-six (60) PICCs were inserted during severe thrombocytopenia (platelets < 50 × 10(9)/L), seventy (70) during severe neutropenia (neutrophils < 0.5 × 10(9)/L) and thirty-eight (38) during antithrombotic prophylaxis. Predominantly, patients had Lymphoma (50%). The rate of major complication was very low: 15 thrombotic complications PICC-related (4%; 0.36 per 1,000 CVC days), and 3 CRBSI (0,8%; 0.07 per 1,000 CVC days) during neutropenia. Mechanical complications occurred in 52 catheters, and were accidental dislodgement (30), catheter break (3), catheter inadequate (19); other reasons for catheter removal were completion of therapy (137), lumen occlusion (19) and death (58). Interesting, taking in account the underlying disease, lymphoma and leukemia patients have, respectively, an increased risk of developing a CRBSI and a thrombotic PICCs-complication when submitted to hematopoietic stem cell transplantation (SCT) (see table 1). However, compared with allogeneic/autologous stem cell transplant group, the intensive chemotherapy group was associated with a marginally lower incidence of CRBSI complication rate (0.6 % vs 1.0 %, 0.10 vs 0.60 per 1,000 CVC days) [odds ratio (OR) 2,042]; no relevant differences in terms of thrombotic complications between the two cohorts (4.11 % vs 4.17%), 0.29 vs 0.39 per 1,000 CVC days) [odds ratio (OR) 1.014]. Conclusions:Our findings suggest, therefore, PICC devices are a viable and safe option for management of the haematology patients receiving intensive chemotherapy and even in patients particularly prone to infective and thrombotic complications such as patients receiving blood stem cell transplantation.Table 1Outcomes according to underlying disease and relative adhibitionDiagnosisChemotherapyASCTStatisticsOdds Ratio% Definite CRBSI% Thrombosis% Definite CRBSI% ThrombosisDefinite CRBSI (%)Definite CRBSI per 1000 PICC daysTrombosis (%)Trombosis per 1000 PICC daysRange (days)Means (days)OR CRBSIOR ThrombosisLymphoma (n. 182)0.694.162.632.631.100.103.850.344–336146.33.860.62Acute Leukemia (n 120))0.954.76013.330.830.075.830.4699–432213.803.07Others (n. 62)02.32000.0001.610.196-28779.200Overall0.684.111.394.170.820.074.120.360–482112.942.0421.014CRBSI catheter-related bloodstream infection. PICC peripherally inserted CVC. ASCT allogeneic/autologous stem cell transplant Disclosures:No relevant conflicts of interest to declare.

Peripherally inserted central catheters (PICCs) in the management of oncohematological patients submitted to autologous stem cell transplantation

The aim of our study was to evaluate the feasibility and the safety of the use of peripherally inserted central catheters (PICCs) during autologous peripheral blood stem cell transplantation. Sixty PICCs were inserted in 57 patients (23 females and 34 males; mean age 48, range 19-68 years) and remained in place for an overall period of 1,276 days. All PICCs were positioned by a team of specifically trained physicians and nurses and utilized by specifically trained nurses of our hematology unit. No major insertion-related complications were observed; the only complication during insertion was one local hematoma (1.6 %) due to accidental arterial puncture. Late complications were accidental catheter removal (5 %, 2.3 per 1,000 PICC days), symptomatic catheter-related venous thrombosis (5 %, 2.3 per 1,000 PICC days), and catheter-related bloodstream infection (CRBSI; 3.3 %, 1.5 CRBSI per 1,000 PICC days). The reasons for catheter removal were completion of therapy (42 patients, 70 %), fever of unknown origin (9 patients, 15 %), catheter-related thrombosis (2 patients, 3.3 %), CRBSI (2 patients, 3.3 %), accidental removal (3 patients, 5 %), lumen occlusion (1 patient, 1.6 %), positive culture from peripheral blood (1 patient, 1.6 %), and death (1 patient, 1.6 %). Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in patients particularly prone to infective and hemorrhagic complications such as patients receiving autologous stem cell transplantation.

Frequency of Peripherally Inserted Central Catheter Complications in Children

This study examined the frequency and types of complications with peripherally inserted central catheters (PICCs) placed in immunocompetent pediatric patients for parenteral antimicrobial therapy. It also sought to determine risk factors associated with those complications. Complications occurred at a frequency of 19.3/1000 PICC days, and greater than 30% of PICCs developed at least one complication. Risk factors for complication include double-lumen PICCs, PICCs placed in the femoral vein, younger age, and greater number of daily doses.

Safety and Efficacy of An Educational Program in Reducing Complications of Peripherally Inserted Central Catheters (PICCs) in Haematological Patients,

Abstract 4219 Purpose.Patients with haematological disorders frequently require the insertion of medium or long-term central venous catheters (CVCs) for stem-cell transplantation, the administration of chemotherapy, or transfusion of blood products. Although peripherally inserted central catheters (PICCs) have been in use for many years, little data exist on their use in patients receiving intensive chemotherapy. Methods:Evidence-based interventions were implemented in our department in December 2010, and include:1.An high level nurse education program for correct practices and prevention of catheter-associated complications. was developed for PICC nursing team;2) The use of ultrasound guide for the insertion of the tip of PICCs, thanks to a special operator training; 3) Bedside placement and confirmed PICC tip placement by chest radiography after removal of the guidewire and before the securing of the catheter; 4) Maintenance of maximum sterile barrier precautions during PICC insertion and aftercare; 5) chlorhexidine preparation, replace 10% povidone iodine for skin antisepsis; 6) adoption of PICC patient nurse archive, including the information of weekly PICC line review at our department for each patient. Here, we carried out a clinical investigation to determine the efficacy of these interventions in reducing the rate of PICC-related complications (thrombotic events, exit site infection and other complications requiring early removal of PICCs) and to compare PICCs-specific complications (CR-BSI) with a cohort population defined as each consecutive CVC non tunneled inserted over a 6-month period (May–November 2009), and before these evidence-based interventions. Results:Ninety-five PICCs were in place for a total of 7,295 PICC days ( range, 1–331 days; mean, 76,7 days), and fifty-one CVCs were inserted before these interventions (range, 3–577 days; mean, 176,2 days). Sixty-six PICCs were inserted during severe thrombocytopenia (platelets < 50 × 10(9)/L), and 70 during severe neutropenia (neutrophils < 0.5 × 10(9)/L). The majority of the patients were affected by leukaemia, and PICCs were inserted to ensure adequate access throughout chemotherapy. There were 2 thrombotic complications PICC-related (0,27 per 1,000 CVC days), and only one CRBSI (0,14 per 1,000 CVC days) during neutropenia. Other mechanical complications occurred in 11 catheters, and were accidental dislodgement (4), catheter break (3), catheter inadequate (4). Compared with CVCs group, the PICCs group was associated with a lower incidence of CRBSI complication rate (1,05% vs 41,17%, 0,14 vs 3,67 per 1,000 CVC days) [odds ratio (OR) 0,051; relative odds reduction (ROR) 0,98]. Conclusions:Our results indicate that a training and competence assessment program is effective in reducing the main complications PICCs-related in haematological setting.Tab 1Catheter outcomes, by devicen=95 PICCsn=51 CVCsNumberPercentage (%)NumberPercentage (%)Male4850.5%3058,8%Female4749,40%2141,2%Mediane AgeRange 17–82 years49.1Range 23–78 years50,5Type of catheter:Silicon rubber66.3%CVC ST (short term)3568,63%Polyurethane33.1%CVC LT (Long term)1631,37%Polyurethane power injectable8690.5%Definite CRBSI% infectionPer 1000 CVC daysrange (days)Means (days)ORPICCs (n.95)1,050,141–33176,790.0151CVCs (n.51)41,173,673–577176,2CRBSI catheter-related bloodstream infection. PICC peripherally inserted CVC. CVC central venous catheter. Disclosures:No relevant conflicts of interest to declare.

2005 Herbst Award Recipient Profile

Parenteral nutrition is administered through a central venous catheter(CVC). Peripherally inserted central catheters (PICC) are appropriate for home parenteral nutrition (HPN). The objective of this study was to examine a group of HPN patients with a PICC in place for more than six months, and the complications associated with PICC removal. Medical records from one home infusion pharmacy were retrospectively reviewed for PICC characteristics and complications leading to removal. Nineteen adult HPN patients had 26 PICC placements. Total PICC days were 22,262 with a mean of 856 (265-2500) days. Seven PICCs were in place for 3 to greater than 5 years. The overall complication rate was 0.58/1000 CVC days. Catheter related bloodstream infection (CRBSI) was the main cause of PICC removal. There was no evidence of symptomatic thrombosis. Patients experienced no infusion related complications. The PICCs were 88% polyurethane, 65% double lumen, and 54% were 5 Fr. No patient received alcohol or antibiotic lock therapy, and 8 patients had successful alteplase administered at least one time. All patients needed caregiver assistance for site care and dressing changes, but were independent in HPN infusion and flushing. This group of patients demonstrated that PICCs are a viable option HPN administration. The PICC overall complication rate was very low, and the most frequent complication leading to removal was CRBSI. The infection rate of 0.36/1000 CVC days is considered very low in an HPN population. This is the only HPN infusion study to date reporting 7 PICCs lasting 3 or more years, with 2 lasting greater than 5 years without complications resulting in removal. Patients received their prescribed therapy reliably and without interruption with this device. Larger studies are needed to confirm the efficacy of maintaining a PICC for very long-term HPN administration.

High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours.

Peripherally inserted central catheters (PICC) have been used extensively as a cost-effective and safe form of medium-term intravascular access. There are only limited data about complications of PICC lines in oncology patients despite theoretical concerns about the higher risks of complications in these patients as a result of cancer itself and cancer therapy. To document the frequency and type of PICC complications in patients with solid tumours. All patients with solid tumours who were treated at Flinders Medical Centre, Adelaide, South Australia, Australia between January 2000 and March 2001 were included in a retrospective review of PICC complications. Twenty-seven PICC lines were inserted in 17 patients; 40.7% (11/27) of PICC lines developed complications requiring early removal of the PICC. Complications encountered were sepsis (systemic and cellulitis), thrombosis, blockage and leakage. Septic complications were found at a rate of 8/1000 PICC days or 25.7% (7/27) of PICC inserted. The median dwell time was 20 days. The mean time for a complication to occur was 27.5 days. The present study demonstrates a high rate of complications, which is higher than the complication rates reported in studies of non-oncology patients. PICC lines should be used with caution in patients with solid tumours. Prospective studies of the factors influencing the incidence of complications might be warranted.

Peripherally inserted central catheters revisited

Background: This study compares central venous catheters (CVC) and peripherally inserted central catheters (PICC) for indications for insertion, complications, and economic impact. Methods: A retrospective review of 838 (283 CVC, 555 PICC) consecutively placed venous catheters reflected 49,365 CVC and 11,814 PICC days. Results: There were 57 (20%) complications in the CVC group, 197 (35%) complications in the PICC group. PICC were associated with a statistically significant increase in the incidence of catheter malfunction ( P = 0.0005), arm vein phlebitis ( P = 0.0004), and overall complications ( P = 0.00001). A higher complication rate was noted in PICC inserted for chemotherapy ( P = 0.00001) and parenteral hyperalimentation administration ( P = 0.04). Charges for inpatient insertion of PICC and CVC were $500 and $2,500, respectively. Conclusions: PICC have a significantly higher complication rate than CVC. PICC provide cost-effective central access of 2 to 3 weeks’ duration, reserving operatively placed CVC for longer access requirements.