Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment

Abstract

Purpose So far there is little evidence on peripherally inserted central venous catheter (PICC) in radiation oncology patients maintaining the access during the periods of ambulatory and hospital treatment. Methods A total of 522 PICC placements in 484 patients were performed between 11/2011 and 07/2016 at the Department of Radiation Oncology and analysed retrospectively for complications and treatment-and patient-related factors during ambulatory and hospital inpatient use. On initial hospitalization, all patients received a multimodal radio-oncological treatment consisting of radiation and intravenous therapy administered via the PICC. Results A total of 18,292 catheter days were documented. Median follow-up from catheter insertion to their removal was 37 days (1-97). The overall complication rate was 4.1 per 1000 catheter days (n = 75, 14.4%). Complications were similar between the cohort of outpatient 3.6 per 1000 catheter days and the cohort of inpatient 4.8 per 1000 catheter days (OR 0.976; 95% CI [0.598; 1.619]; p = 0.924). Severe bloodstream infections occurred at a rate of 0.60 per 1000 catheter days (n = 11, 2.1%), deep vein thrombosis at a rate of 0.82 per 1.000 catheter days (n = 15, 2.9%) and local inflammation at a rate of 1.26 per 1.000 catheter days (n = 23, 4.4%). Only immunotherapy could be identified as an independent risk factor for complications (OR 5.6; 95% CI [2.4; 13.1]; p < 0.001). Conclusion Using PICC in outpatients is not associated with an elevated risk of complications. Particular attention should be payed to early identification of PICC associated bloodstream infections. Immunotherapy is an independent risk factor for local skin complication.

Magnetic Tracking and Electrocardiography-Guided Tip Confirmation System Versus Fluoroscopy for Placement of Peripherally Inserted Central Catheters: A Randomized, Noninferiority Comparison

“…Malposition may increase the risk of catheter tip migration and thus promote thrombosis and infection [2,6,15] particularly if the PICC tip is located in the upper two-thirds of the superior vena cava. Venous thrombosis, one of the most serious complications of PICC implantation, may result in bloodstream infection or pulmonary embolism.…”

“…However, malposition of PICC is given as 20–76% [ 3 , 4 ] and X-ray confirmation is needed prior to use of the catheter. In contrast, PICC placement under fluoroscopic control goes along with nearly 100% proper tip position [ 5 , 6 ]. However, radiation exposure and staff requirements are increased.…”

Incidência de complicações no uso do Peripherally Inserted Central Catheter em uma coorte de adultos hospitalizados

“…Quanto à indicação do PICC, cada serviço de saúde possui suas peculiaridades. Hospitais oncológicos utilizam este tipo de cateter para infusão de quimioterápicos, imunoterápicos e nutrição parenteral (SIMONETTI et al, 2020;MIELKE;WITTIG;TEICHGRÄBER, 2020;REIS et al, 2019;YAP et al, 2006). Já na especialidade cardiológica o PICC é indicado para infusão de amiodarona (GOLDHABER, 2011).…”

“…Apesar de não ter sido descrito nesta amostragem nenhum caso, provavelmente devido à limitação do n de pacientes, a trombose é uma complicação incidente, atingindo de 1,5% a 13,91% dos pacientes (MCDIARMID et al, 2017;BERTOGLIO et al, 2016;CHOPRA et al, 2013;MIELKE;WITTIG;TEICHGRÄBER, 2020).…”

“…A remoção do cateter causada pela oclusão não aconteceu na amostra. Porém, foi descrita como complicação durante a internação em até 8,57% dos casos representando uma alta frequência (DUWADI; ZHAO;BUDAL, 2019;MIELKE;WITTIG;TEICHGRÄBER, 2020;PAJE et al, 2018). Foi menor apenas quando comparada a pacientes em uso de PICC em domicílio(LAM et al, 2018) e em uma coorte com 13408 pacientes(SMITH et al, 2017).…”