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

Abstract

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.

Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients

“…As previously mentioned, patients presenting with hematological malignancies were at higher risk of PICCrelated infections, and, particularly in patients necessitating an autologous or allogeneic stem cell transplantation (OR 6, 95 % CI [1.2-29.3]) whose PICC-related infection rate was 2.93 per 1000 catheter-days. This rate was pretty close to the one that Bellesi et al found in their cohort of 60 autologous peripheral stem cell transplantation procedures (2.3 per 1000 catheter-days) [18]. Worth et al also considered that the indication of hematopoietic stem cell transplantation as a potential PICC-related infection risk factor but did not obtained significant results [15].…”

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

“…Few studies focusing on the use of PICCs in hematologic patients have been reported in the literature (Table 6) [4,6,[10][11][12]. These studies showed a variable and broad rate of CRBSIs, probably related to the technique of PICC insertion used (blind vs eco-guided), to the different criteria for the definition and detection of these complications, to the collection of data which was generally retrospective and to the [12].…”

“…In the last 10 years, after the introduction of ultrasonographic techniques to monitor PICCs' insertion, the rate of thrombosis has decreased significantly and has been reported to occur in about 2-5 % of patients [6,17,18]. A systematic review and meta-analysis of the literature aimed at comparing the frequency of venous thromboembolisms in PICCs and other CVADs has recently been published [18].…”

“…PICC lines provide a reliable central venous access for different categories of patients, in particular due to the easiness of the insertion technique with a possible bedside placement and a low risk of complications. In the last years, due to the security of the PICC's profile, the number of devices inserted has significantly increased in hematologic patients, a population who very often presents neutropenia and thrombocytopenia with a consequent exposure to severe and frequent infective and hemorrhagic risks [6,7]. Maki et al [8] reviewed the risk of CVAD-related infections in 200 prospective studies in several categories of patients.…”

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

“…A recent meta-analysis of 11 studies that compared the risk of thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of catheter-related thrombosis (CRT) (odds ratio 2.55, 1.54-4.23, p<0.0001) [6]. Because of these concerns, only a few published studies have focused on the clinical usefulness and safety of PICCs in patients with HM, especially in those receiving intensive chemotherapy [2,3,[7][8][9][10][11][12]. A comparison between these published studies and our current study needs to be carefully performed because the population, endpoints, and definitions greatly varied in these previous studies.…”