Dataset Information

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.

SUBMITTER: Mielke D

PROVIDER: S-EPMC7447660 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Publications

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

Mielke Dorothea D Wittig Andrea A Teichgräber Ulf U

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 20200122 10

<h4>Purpose</h4>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.<h4>Methods</h4>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 i ...[more]

PMID: 31970514

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Project description:ImportanceLittle is known about the safety of midline catheters vs peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT).ObjectiveTo compare outcomes from midline catheters vs PICCs for OPAT.Design, setting, and participantsThis retrospective cohort study included patients who received antimicrobial therapy through a midline catheter or PICC between January 2017 and November 2023 across 69 Michigan hospitals. Because peripherally compatible OPAT was the indication of interest, vancomycin therapy was excluded. Data were analyzed from April to June 2024.ExposuresInsertion of a midline catheter or PICC for OPAT following hospitalization.Main outcomes and measuresThe primary outcome was major device complications (ie, catheter-related bloodstream infection or catheter-related venous thromboembolism). Secondary outcomes included minor device complications (eg, catheter dislodgement, occlusion, tip migration, infiltration, superficial thrombophlebitis, or exit site concerns) and device failure, defined as catheter removal following device complication. Cox proportional hazards regression models were fit to device type and outcomes, adjusting for patient and device confounders and device dwell.ResultsOf 2824 included patients, 1487 (53.5%) were male, and the median (IQR) age was 66.8 (55.9-77.1) years. Of 2824 devices placed for OPAT, 1999 (70.8%) were midline catheters and 825 (29.2%) were PICCs. The median (IQR) dwell time was 12 (8-17) days for midline catheters and 19 (12-27) days for PICCs (P < .001). A major device complication occurred in 44 patients (1.6%) overall, including 16 (0.8%) with midline catheters and 28 (3.4%) with PICCs (P < .001). OPAT delivered via midline catheters was associated with a lower risk of major complications vs PICCs (adjusted hazard ratio [aHR], 0.46; 95% CI, 0.23-0.91). Risks of minor complications and device failure were similar across device types (minor complications: 206 of 1999 [10.3%] vs 114 of 825 [13.8%]; aHR, 1.07; 95% CI, 0.83-1.38; device failure: 191 of 1999 [9.6%] vs 100 of 825 [12.1%]; aHR, 1.26; 95% CI, 0.96-1.65). For device dwell of 14 or fewer days, midline catheters were associated with a lower risk of major complications (12 of 1324 [0.9%] vs 16 of 304 [5.3%]; aHR, 0.29; 95% CI, 0.12-0.68) and similar risk of failure (151 of 1324 [11.4%] vs 52 of 304 [17.1%]; aHR, 0.79; 95% CI, 0.56-1.12) vs PICCs. For dwell longer than 14 days, no significant difference in rates of major complications (4 of 675 [0.6%] vs 12 of 521 [2.3%]; aHR, 0.42; 95% CI, 0.13-1.40) or device failure (40 of 675 [5.9%] vs 48 of 521 [9.2%]; aHR, 1.02; 95% CI, 0.64-1.61) were observed.Conclusions and relevanceIn this study, midline catheters appeared to be safe alternatives to PICCs for OPAT, particularly if infusions were planned for 14 or fewer days.

Project description:ImportancePeripherally inserted central catheters (PICCs) are frequently used for peripheral intravenous therapy (IVT) that could be administered through a peripheral midline venous catheter (MVC).ObjectiveTo assess the noninferiority of MVCs compared with PICCs as a reliable vascular access for peripheral IVT and blood draws for IVT that does not require a central VC.Design, setting, and participantsThis randomized clinical trial was conducted in a single tertiary care center from September 2018 to March 2022. Participants were all consecutive adult patients who were referred for PICC and eligible for MVC. Patients likely to require a central VC (those in the critical care unit, those with kidney failure, or those requiring a multilumen VC) were excluded. Analyses were based on the evaluable population.InterventionsParticipants were randomized 1:1 to either MVC or PICC. For the MVC group, a 20-cm-long, 4F (French), single-lumen MVC without a valve was used without fluoroscopic assistance. For the PICC group, a 4F, single-lumen PICC without a valve was positioned under fluoroscopy at the cavoatrial junction.Main outcomes and measuresThe primary outcome was the percentage of patients without VC-related adverse events or dysfunctions requiring medical intervention during follow-up. A noninferiority test was performed to compare the proportion of adverse events or dysfunctions between the MVC and PICC groups. A noninferiority margin was set at 10% and a 5% 1-sided significance level.ResultsOf the 6821 patients referred to the tertiary care center for PICC insertion, 294 (180 males [61.2%]; median [IQR] age, 56.3 [38.2-66.7] years) were randomized to receive MVCs (n = 146) or PICCs (n = 148); 135 and 137 participants, respectively, were included in data analysis after exclusion of those who did not complete follow-up. Ninety of 135 patients (66.7%) in the MVC group and 128 of 137 (93.4%) in the PICC group were without VC-related adverse event or dysfunction. The noninferiority of MVC could not be demonstrated (P > .99 for noninferiority).Conclusions and relevanceIn this randomized clinical trial, MVCs were associated with a significantly higher percentage of patients with VC-related adverse events or dysfunctions and could not be demonstrated as a noninferior alternative to PICCs.Trial registrationClinicalTrials.gov Identifier: NCT03502980.

Project description:BackgroundCurrently, peripherally inserted central catheters (PICCs) are widely used; however, there are associated problems due to catheter-related thrombosis (CRT). According to the existing literature and guidelines, 3-6 months of anticoagulation therapy is recommended, but these recommendations are based on analogous deep vein thrombosis of the lower limbs. More specific management strategies need to be developed, and the safety and effectiveness of these strategies needs to be investigated.MethodsSome studies have suggested that catheter removal alone is a reasonable option, especially for patients with a higher risk of bleeding. We conducted a retrospective study of hospitalized patients from a single center who were diagnosed with PICC-related thrombosis. Among the 85 patients who met the inclusion criteria, 63 patients were treated with catheter removal alone, and 22 patients received anticoagulation therapy after catheter removal. The progression of thrombosis and bleeding in the two groups were compared. Most patients who underwent catheter removal alone had hematological malignancies, and thrombocytopenia had occurred during chemotherapy.ResultsAfter PICC removal, no patients in the anticoagulation therapy group developed progressive thrombosis, while 10 patients in the catheter removal alone group developed progressive thrombosis or pulmonary embolism (PE), including one case of PE, four cases of secondary upper extremity deep vein thrombosis (UEDVT), and five patients showed obvious aggravation of thrombosis after catheter removal, and were administered repeated anticoagulant therapy. In the PICC removal + anticoagulation treatment group, major bleeding increased significantly (28.6% vs. 4.7%, P=0.006).ConclusionsCompared to the PICC removal + anticoagulation treatment group, the risk of major bleeding in the catheter removal alone group was significantly reduced. In some patients with an increased bleeding risk, catheter removal alone may be a safer and more effective option than catheter removal with anticoagulation treatment for CRT.

Dataset Information

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

Purpose

Methods

Results

Conclusion

Publications

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

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