Peripherally inserted central catheters in allogeneic hematopoietic stem cell transplant recipients

Abstract

Background Central venous catheters (CVC) are essential for the management of patients with hematologic malignancies, facilitating chemotherapy infusion, antibiotics, parenteral nutrition, blood products, and blood samples collection. In this population, peripherally inserted central catheters (PICC) seem to be associated with lower complications, compared with conventional percutaneously inserted devices (CICC). Data on the PICC in allogeneic hematopoietic stem cell recipients (allo-HSCT) are limited. Methods We have prospectively evaluated the safety and efficacy of 100 polyurethanes or silicone PICC, inserted into 100 adult allo-HSCT recipients, at the Hematology of Sapienza University of Rome (Italy), between October 2012 and August 2017. ResultsThe median duration of PICC placement was 117 days. Overall, 68% of patients maintained the device for the entire transplant procedure and PICC were removed after day 100 from allo-HSCT; of these, 44% did not experienced any PICC-related complications. Catheter-related bloodstream infections (CRBSI) occurred in 32% of patients (2.5/1000 PICC days), associated with thrombosis in 8 cases. CRBSI were observed in 42% of patients with polyurethane and 20% with silicone PICC (p = 0.02). Catheter-related thrombosis occurred in 9% of patients, never requiring anticipated PICC removal. Mechanical complications occurred in 15% of cases (1.2/1000 PICC days). On the whole, adverse events were manageable and did not affect transplant outcome. No deaths related to PICC-complications were observed. Conclusions PICC are a safe and reliable long-term venous access in allo-HSCT recipients.

Changes in Central Venous Catheter Use in the Hematology Unit with the Introduction of Ultrasound Guidance and a Peripherally Inserted Central Venous Catheter

“…Some studies have reported the safety and usefulness of PICCs for hematologic diseases, including stem cell transplantation (25,(27)(28)(29); our study also showed safe and effective profiles. Although a PICC can be used in chemotherapy, blood transfusion, and parenteral nutrition to avoid problems associated with the use of a conventional CVC, PICCs were found to be inconvenient in cases in the present study requiring bolus injection, such as during intensive care, resuscitation, or stem cell infusion.…”

Catheter-related bloodstream infection associated with multiple insertions of the peripherally inserted central catheter in patients with hematological disorders

“…Most studies are single-institution studies and demonstrate that PICCs are safer than CVCs in terms of the risk of catheter-related complications and CRBSI. While the evidence is limited, some studies demonstrated that the use of polyurethane catheters in allogeneic hematopoietic stem cell transplant recipients 20 and acute leukemia in adults are risk factors of CRBSI 21 . Similarly, our findings also suggest that patients with progressive diseases may be at a higher risk for CRBSI.…”

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

“…Femoral vein insertion of PICC [11,12] have reported the incidence of PICC-related CRBSI is between 8.11 and 12.35%. The results of this study have shown that the incidence of CRBSI in our department is 10.62%, which is consistent with the results of related studies.…”