Patterns of use and outcomes of peripherally inserted central catheters in hospitalized patients with solid tumors: A multicenter study

Abstract

BACKGROUND:The risk of peripherally inserted central catheter (PICC)-related complications in patients hospitalized with solid tumors remains unclear. Existing studies are limited by single-center, outpatient designs and include heterogenous patients. METHODS: A retrospective cohort study was designed and included adult patients with solid organ cancers who were admitted to a general medicine ward or intensive care unit and received a PICC. Data were collected from November 2013 to December 2019 at 50 Michigan hospitals. Major complications were defined as central line-associated bloodstream infection, deep vein thrombosis, pulmonary embolism, and catheter occlusion. Hospital variation in PICC use and outcomes was examined. RESULTS: Data included 3235 hospitalized patients with solid tumors who had PICCs placed for 51,047 catheter days. Most catheters were double-lumen devices (57.0%). Notably, 17.5% of patients had another central venous catheter at the time of PICC insertion. The most common indications for PICC use were antibiotics (34.5%) and difficult access or blood draws (21.6%); chemotherapy was the primary indication in only 15.7% of patients. A major PICC-related complication occurred in 491 patients (15.2%); catheter occlusion was the most prevalent complication (n = 322; 10.0%) followed by deep vein thrombosis (n = 116; 3.6%), central line-associated bloodstream infection (n = 82; 2.5%), and pulmonary embolism (n = 20; 0.6%). Significant variation in indications for PICC use, device characteristics, and frequency of major complications across hospitals was observed (p < .001). CONCLUSIONS: PICCs were associated with significant complications in hospitalized patients who had solid malignancies and were often used for reasons other than chemotherapy. Policies and guidance for the appropriate use of PICCs in oncologic patients appear necessary.

Peripherally Inserted Central Venous Catheter (PICC) Related Bloodstream Infection in Cancer Patients Treated with Chemotherapy Compared with Noncancer Patients: A Propensity-Score-Matched Analysis

“…This study has limitations. First, its single-center design could limit the extrapolation of the results, as PICC-related complication rates vary between hospitals [ 15 ]. However, our cohort included a large number of patients from four different oncology departments and one hematology department, representing a mix of different practices.…”

“…In cancer patients treated with chemotherapy, the use of PICCs has increased dramatically [ 11 ] but studies provide conflicting data regarding the risk of CVC-related complications, with some reporting that implantable port catheters are safer [ 12 ], others that PICCs are safer [ 13 ], and finally, some authors report that both devices are equivalent [ 14 ]. Moreover, the risk of PICC-related complications in cancer patients compared with noncancer patients remains poorly assessed [ 15 ]. The complication rate appears to be higher in cancer patients than in noncancer patients, especially with regard to the PICC thrombosis rate [ 16 , 17 ].…”

Mediport Use As an Acceptable Standard for CAR T Cell Infusion

“…Tunneled venous catheters with external line access, such as Broviacs ® and Hickmans ® , are functional line options, but in clinical practice are more often placed for allogeneic hematopoietic stem cell transplantation (HSCT) and are not usually present in patients receiving upfront leukemia therapy or CAR T cell therapy. While PICC lines can be placed for the administration of CAR T cell therapy, PICCs have demonstrated significant risk of complications, including central-line associated infections, catheter occlusion, and thrombosis (deep vein thrombosis and pulmonary embolism) (9).…”

Efficacy of mFOLFOX6 plus bevacizumab regimen in advanced colorectal cancer after deep hyperthermia: a single-center retrospective study

“…There is evidence that a dual immune checkpoint inhibitors (ICI) regimen has shown even greater benefits for dMMR/MSI-H metastatic colorectal cancer ( 7 ). Chemotherapy combined with targeted drugs is the first-line standard treatment for advanced colorectal cancer, but there is still a risk of progression after drug resistance, and adverse events in cancer patients are obvious ( 8 , 9 ). Randomized controlled trials (RCT) have shown that patients receiving FOLFOX6 plus bevacizumab as first-line treatment for RAS mutant colorectal cancer had objective response rates of 54.5%, median progression-free survival 9.5 months, and median overall survival of 25.7 months; the incidences of proteinuria and hypertension were 9.9% and 8.3%, respectively ( 10 ).…”