Infection Rate of Hickman Catheters Versus Peripherally Inserted Central Venous Catheters in Oncology Patients

Abstract

Objective: To compare the incidence of catheter-related infection in the bloodstream and non-infectious complication rate of Hickman catheter and peripherally inserted central venous catheter (PICC) in oncology patients. Methods: A retrospective study was performed of oncology patients who underwent Hickman catheter or PICC placement at the radiology department of a regional hospital in Hong Kong from January 2008 to December 2013. The catheter-related bloodstream infection rate, time to infection onset, and non-infectious complication rate of the Hickman group and PICC group were evaluated and compared. Results: During the study period, 161 Hickman catheters and 29 PICCs were inserted in oncology patients (n = 190). There were 38 cases of catheter-related bloodstream infection in the Hickman group and four cases in the PICC group. The catheter-related bloodstream infection rate for all catheters, Hickman group, and PICC group was 1.364, 1.340 and 1.654 per 1000-catheter-days, respectively. For non-infectious complications, 15 of 161 Hickman cases had complications (6 catheter blockage, 5 leakage, 4 migration and dislodgement). In the PICC group, 6 of 29 had complications (3 blockage, and 3 migration and dislodgement). There was, however, no statistically significant difference between the Hickman and PICC groups in terms of number of infections (p = 0.241), time to infection onset (p = 0.187), non-infectious complication rate (p = 0.101), and overall complication rate (p = 0.766). Conclusion: With the less invasive nature of PICC insertion, it provides a viable means of vascular access for oncology patients.

Peripherally inserted central catheters inserted with current best practices have low deep vein thrombosis and central line–associated bloodstream infection risk compared with centrally inserted central catheters: A contemporary meta-analysis

“…Following screening at title-abstract and full-text level, 31 unique studies remained that provided data for meta-analyses for either or both of DVT and CLABSI (Figure 1). 1,4–11,30–51…”

“…Study characteristics are presented in Table 1. In total, 21 studies included oncology patient populations, 1,7–11,30–33,35,37–40,42,43,46,48–50 8 included patients on HPN or another parenteral nutrition, 8,10,11,31,33,36,38,50 and 11 included ICU or other critical care patients. 5–7,34,41–44,47,49,51 Notably, Bhutani et al 45 featured majority chronic kidney disease (CKD) patients, and Fearonce 5 focused on burn-patients.…”

“…Ratings for included observational studies were generally split. In total, 11 studies (58%) were rated good, 4,5,8,10,11,30,32,36,37,39,41 and 8 were rated poorly, 7,9,31,33–35,38,40 of the 19 studies that contributed to the CLABSI analyses. Twelve of 23 (52%) DVT studies were rated “good” or of “low” concerns of bias 5,6,8,11,32,37,42,43,47,49–51 while the rest were rated “poor” or of “unclear” concerns of bias.…”

“…Nineteen studies either reported CLABSI per 1000 catheter days as an event rate or included enough information for it to be appropriately calculated. 4,5,7–11,30–41 The meta-analysis estimated a 48% reduction in CLABSI risk for patients with PICCs compared to CICCs (IRR = 0.52, 95% confidence interval (CI): 0.30–0.92) (Figure 2), attributable to a mean rate of 4.09 and 2.12 CLABSIs per 1000 catheter days, for CICCs and PICCs, respectively (Supplemental Appendix D).…”

Right Securement, Dressing, and Management

“…The most common reason for PIVC failure is due to infiltration or dislodgement (Royer 2003), and it is estimated that 10% simply fall out (Rickard et al 2015 (Lorente et al 2004). In a retrospective study looking at tunneled CVAD and PICC complications, Wong et al 2015identified a dislodgement/migration rate of 3 out of 29 PICCs (10.3%) versus the tunneled CVAD group of 4 out of 161 patients (2.4%) (Wong et al 2015).…”