Reducing the risk of peripherally inserted central catheter line complications in the oncology setting

Abstract

At our institution, a retrospective review of peripherally inserted central catheters (PICCs) in oncology patients had previously demonstrated a complication rate of 40.7%. Since then we have implemented strategies to reduce complications including staff and patient education, insertion technique modification and PICC maintenance utilizing a PICC nurse. The objectives of this study were to evaluate the recent PICC complication rate and to compare it with the previously reported findings. Prospectively collected PICC complication data and medical records from all patients with solid tumours who had PICCs inserted in 2003 were analysed. A historical cohort comparative analysis was performed using our PICC complication rate from 2000 to 2001. Eighty-eight PICC lines were inserted in 73 patients under radiological guidance. The median PICC dwell time was 44 days (1-524 days). The overall complication rate was 15.9% (14/88) or 2.0 complications per 1,000 PICC-days. Infections developed in 5.7% (5/88) and thrombotic events occurred in 4.5% (4 /88) of PICCs. The mean time to complication was 45 days. The complication rate for 2003 was significantly lower than the rate for 2001 (P = 0.006), especially of infective complications (P = 0.004). Strategies introduced to reduce PICC complications may have been the reason for this improvement.

Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience

“…The total complication rate in our study was less than that of general cancer patients (16)(17)(18), and similar to that of non-cancer patients (5,8). Premature PICC removal rate in our study, representing a definitional complication related end point particularly in the retrospective setting, was also similar to that in other settings (5,(16)(17)(18).…”

“…Premature PICC removal rate in our study, representing a definitional complication related end point particularly in the retrospective setting, was also similar to that in other settings (5,(16)(17)(18). However, most of the premature PICC removals in the present study were self-removals.…”

“…Second, all cases were performed by an expert interventional radiologist using ultrasonography or fluoroscopic guidance, which may have resulted in fewer CRBSI complications. PICC insertion under strict sterile condition, not via the blinded bedside approach, may decrease immediate procedure-related risks and CRBSI and may increase PICC durability (17,18).…”

Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients

“…A retrospective study found that 40.7% of PICC lines (11 out of 27) inserted in medical oncology patients developed complications requiring early removal of the PICC [3]. Other published studies showed similarly or even high complication rates in cancer patients [4,5,23].…”

An evaluation of peripherally inserted central venous catheters for children with cancer requiring long-term venous access

“…Recently, PICC has been used for both adults and children with cancer and several reports attest to its utility [5][6][7][8][9]. Through our experience in treating children with various kinds of malignancy, we also assessed the experience with PICC particularly with regard to the patient's characteristics, catheter life, reasons for catheter removal, and complications.…”