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

Abstract

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.

S3-Leitlinie Heimenterale und heimparenterale Ernährung der Deutschen Gesellschaft für Ernährungsmedizin (DGEM)

“…Die Arbeitsgruppe fand 13 83), während die Einarm-Studien keine signifikanten Unterschiede ergaben. Entsprechend soll die Wahl der ZVK auf die Behandlungsdauer, dem Niveau der Katheterpflege und den zugrunde liegenden Komorbiditäten ausgerichtet werden [249].…”

“…Die ESPEN- und ASPEN-Leitlinien 47 241 für CIF empfehlen keine PICCs für Langzeit-HPN (siehe Empfehlung 46). Viele Studien berichten jedoch über eine erfolgreiche Anwendung von PICCS von bis zu 4 Jahren 81 85 168 244 245 246 247 248 249 .…”

“…Ein systematisches Review mit Metaanalyse zeigte ungenügende Evidenz für eine Differenz in CRBSI-Raten zwischen PICC und getunnelten Kathetern (RR für PICC 0,41; 95 % CI 0,14-1,17); tiefere CRBSI-Raten lagen für PICC im Vergleich zu Ports vor (RR 0,16; 95 % CI 0,04-0,64).Die ESPEN-und ASPEN-Leitlinien[47,241] für CIF empfehlen keine PICCs für Langzeit-HPN (sieheEmpfehlung 46). Viele Studien berichten jedoch über eine erfolgreiche Anwendung von PICCS von bis zu 4 Jahren[81,85,168,[244][245][246][247][248][249].Die Metaanalyse zum Thema tunnelierte ZVKs vs. PICC in Medline, Pubmed und Scopus mit 17 Studien, davon 12 Einarm-und Vergleichs-Studien, ergab, dass in den Vergleichsstudien PICC signifikant geringere CRBSI-Raten zeigten (CRBSI RR 0,40; 95 % CI 0,19-0,…”

From hospitalisation to primary care: integrative model of clinical pharmacy with patients implanted with a PICC line—research protocol for a prospective before–after study

“…15 16 Peripherally inserted central catheters (PICC lines) are associated with numerous clinical (eg, infections 17 ) and mechanical complications (eg, catheter occlusions). [18][19][20][21][22][23][24][25][26][27] PICC lines are useful for the administration of irritating products or for the repeated collection of blood samples. PICC lines are recommended when the duration of catheterisation ranges from 7 days to 3 months.…”

“…Complications will be documented on specific forms to harmonise data collection. Mechanical complications are defined as obstruction or occlusion, 18 breakage or damage to the catheter, 27 migration 34 or dislodgment (accidental withdrawal) of the catheter. 35 Clinical complications are defined as redness around the insertion site (diameter >2 cm), oedema (size difference between the two hands), pain (numeric rating scale) and fever (internal temperature >37°C) as signs of an infection 17 36 and thrombotic events 37 (confirmed by a medical modality such as echography).…”