Safe use of Peripherally Inserted Central Catheters for chemotherapy of solid malignancies in adult patients: A 1-year monocentric, prospectively-assessed, unselected cohort of 482 patients

Abstract

Introduction: Aim of this study was to analyze the overall complication and failure rates of Peripherally Inserted Central Catheters (PICCs), in a 1-year consecutive unselected cohort of 482 adult patients, affected by non-hematological malignancies undergoing chemotherapy. Methods: Adult outpatients (aged 18–75 years), with an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2, bearing solid tumors and candidates for intravenous chemotherapy were eligible for the study. Exclusion criteria were active infections, coagulopathy (defined as platelet count <50,000/μL and/or prothrombin time more than 18 s), life expectancy <6 months, or inability to give written informed consent. Devices were all implanted in an outpatients’ hospital facility, following predefined evidence-based institutional guidelines and protocols by a PICC-dedicated team at the European Institute of Oncology in Milan, Italy, during the 12-month period from January 1 to December 31, 2019. Results: Five-hundred PICCs were implanted in a cohort of 482 patients during the time interval of this study. Thirty devices were overall removed (6.2%), 23 as a consequence of a complication occurred, and seven inadvertently. The inserted PICCs accounted for a total of 49,718 catheter days in situ, median duration was 85.5 days [interquartile range (IQR): 56–146]. Overall there were 42 (8.7%) complications, corresponding to 0.84 catheter-adverse events (CAE)/1000 PICC-days (95% CI: 0.61–1.14). There were N = 13 (2.7%) thromboses, N = 11 (2.3%) irreversible occlusions, N = 7 (1.5%) accidental removals, N = 5 (1.0%) infections [two Catheter Related Blood Stream Infection (CRBSI) and three exit site/local infection], N = 3 (0.6%) ruptures and N = 3 (0.6%) primary or secondary malpositions. Conclusion: This large prospective study supports the increasing use of PICCs in adult oncology outpatients treated in specialized centers with chemotherapy for non-hematological malignancies. In this clinical setting, PICC failure occurred in 6% only of the inserted devices.

Nursing Effect and Prognosis Analysis of Self-Management Education Model Based on Protective Motivation Theory on Patients with Hematological Tumor after PICC Catheterization

“…This is mainly because, according to the theory of protective motivation, a number of intervention measures such as health education, face-to-face interviews, scenario simulation, and deliberate practice are comprehensively used to strengthen patients' understanding of the seriousness and possibility of improper management of PICC, weaken the internal and external rewards for patients to form bad health behaviors, reduce patients' reaction costs, and stimulate patients' behavior motivation [26]. On the other hand, in the process of health intervention, we should not only pay attention to the strengthening of patients' knowledge related to PICC catheter, make them effectively master the necessary knowledge and skills of PICC catheter self-management, and increase patients' catheter cognitive level, catheter management ability, and confidence but also make patients actively aware of their own problems and overcome the oneness of nurses as the main body of the traditional health education model [26,27]. One month after receiving the self-management education model based on protective motivation theory, the HAMA score of patients was lower compared to routine health education (p < 0:05).…”

Management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices: A systematic review and a GAVeCeLT consensus statement

“…25 In tunneled dialysis catheters, the bleeding risk may range from 0.095% 26 to 1.36% 27 or even to 5.6%. 28 Most studies reporting experiences with insertion of PICCs 29 –31 and FICCs 4 do not report the occurrence of hematoma, though sometimes accidental arterial puncture is mentioned. Though evidence is still scarce, it seems likely that ultrasound-guided puncture of the common femoral vein at the groin may have more risk of bleeding than ultrasound-guided puncture of the superficial femoral vein at mid-thigh.…”

Analysis of risk factors of PICC-related bloodstream infection in newborns: implications for nursing care

“…A multi-center case-control study [14] have showed that after PICC catheterization for more than 2 weeks, the risk of CRBSI continues to increase with the extension of PICC stay. The defense function of newborns with a birth weight of ≤ 1500 g is imperfect, and newborns with Apgar score ≤ 7 are in poor physical condition, which will increase the risk of CRBSI [15,16]. In response to the above risk factors, nurses should take appropriate measures as much as possible to reduce the occurrence of CRBSI, such as daily assessment of extubation indications, appropriate PICC care.…”