The Use of Peripherally Inserted Central Catheter in Amyotrophic Lateral Sclerosis Patients at a Later Stage

Abstract

Background/Aims: To describe the use of peripherally inserted central catheter (PICC), in amyotrophic lateral sclerosis (ALS) at a later stage. Methods: Twenty-five ALS patients in the later stages of the disease underwent PICC insertion followed by parenteral nutrition (PN). For all of them, gastrostomy was non-feasible. Patients were followed until death and monitored for complications. Results: PICC insertion was successful in all patients. Three months after insertion, the mean body weight increased by 4.5% (p = 0.0057). PICC could be maintained until death in all but 1 patient. The mean delay between insertion and death was 4.5 months, but PN was administered for more than 1 year in 2 patients. Complications were noted in 6 patients: sepsis (n = 4), venous thrombosis (n = 1), and upper limb oedema (n = 1), none of them resulting in death. Conclusion: PICC insertion for PN at a later stage of ALS, in patients for whom gastrostomy is non-feasible, appears to be a useful option compared to the central venous catheter.

Short- and Intermediate-Term Use of Peripherally Inserted Central Catheters in Europe: A Systematic Literature Review

“…Inflammation (phlebitis, edema) was reported in 0% to 17% of patients with PICCs 4,6,15,17,18,27,29,33,34,38,46,48 versus 17.5% with PIVCs reported in one study 6 and 0% to 23% with CICCs. 6,17,33 In the study by Griffiths and Philpot, 6 the number of insertion sites showing signs of phlebitis was significantly lower in critically ill patients using PICCs for venous access (17%) compared to PIVCs (65%), P < 0.01, but not compared to CICCs (22%).…”

“…33 The rate of catheter mechanical failure was 5% to 22.3% with PICCs 6,15,18,27,44 and 16% and 11% in PIVCs and CICCs, respectively, in a single study. 6 The percentage of patients experiencing venous thrombosis was 0% to 27.2% with PICCs 4,5,10,12,13,15,16,18,20,26,29,31,33,35,37,38,44,48,49 compared to 3.4% with PIVCs reported in one study 10 and 0% to 9.6% with CICCs. 5,16,17,33 In the study by Bonizzoli et al 16 in which catheters were used for prolonged IV therapy in patients discharged from the intensive care unit, rates of DVT were significantly higher for PICCs compared to CICCs (27.2% vs. 9.6% of patients or 7.7 vs. 4.4 DVTs per 1000 catheter days, P = 0.0007).…”

“…6 Skin reactions were reported in only 2 studies, with cellulitis occurring in 3.2% and 0% of patients with PICCs and PIVCs, respectively, 10 and edema occurring in 4.5% of patients following PICC insertion. 29 Infections in general (sepsis, local infections, and infections at insertion site) occurred in 0% to 21% of patients with PICCs [4][5][6]11,[13][14][15]18,23,26,27,33,35,37,44,[47][48][49] versus 0% to 14% with PIVCs 6,10,14 and 0% to 35% with CVCs. 5,6,11,33 In the study by Toure et al, 33 catheter-associated infection (exit site, tunnel, or pocket infection) rate was lower in patients receiving HPN by PICCs versus CICCs (1.05 vs. 1.87 per 1000 catheter days, P = 0.01).…”

Option of Using Peripherally Inserted Central Catheters in Elderly Patients With Dementia: An Observational Study

“…Several reports have addressed the usefulness of PICCs in the context of malignancy, neuromuscular disease, or hematologic disease (Hashimoto et al, 2017;Juntas-Morales et al, 2017;Park et al, 2016). In addition, previous research has shown that PICC insertion is a relatively low-risk procedure compared with CVC insertion (Brass et al, 2015;Saugel et al, 2017).…”

“…Compared with conventional central venous catheters (CVCs), PICCs are less invasive at insertion and less likely to lead to infection (Chrisman et al, 1999; Safdar & Maki, 2005). PICCs are versatile and can be used short- to long-term, from acute to palliative care, and in patients with a variety of underlying conditions, including malignancy, inflammatory bowel disease, amyotrophic lateral sclerosis, and hematologic diseases (Hashimoto et al, 2017; Juntas-Morales et al, 2017; Park et al, 2016). As used in the treatment of various diseases, PICCs also could be a useful option during the treatment of elderly patients with dementia, although to our knowledge, no currently available reports have addressed.…”