COMPLICATIONS AND PRACTICE VARIATION IN THE USE OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS IN PEOPLE WITH CYSTIC FIBROSIS

Document Type

Article

Publication Date

4-3-2023

Journal Title

Chest

Abstract

BACKGROUND: Peripherally inserted central catheter(s), PICC(s), are commonly used to administer antibiotics to people with cystic fibrosis (pwCF), but their use can be complicated by venous thrombosis and catheter occlusion. RESEARCH QUESTION: Which participant-, catheter-, and catheter management-level attributes are associated with increased risk of complications of PICCs among pwCF? STUDY DESIGN AND METHODS: This was a prospective observational study of adults and children with cystic fibrosis (CF) who received PICCs at ten CF care centers in the US. The primary endpoint was defined as occlusion of the catheter resulting in unplanned removal and/or symptomatic venous thrombosis in the extremity containing the catheter. There were three categories of composite secondary outcomes: difficult line placement, local soft tissue or skin reactions, and catheter malfunction. Data specific to the participant, catheter placement, and catheter management were collected in a centralized database. Risk factors for primary and secondary outcomes were analyzed by multivariate logistical regression. RESULTS: Between June 2018 and July 2021, 157 adults and 103 children over six years of age with CF had 375 PICCs placed. There were 4,828 catheter-days of observation. Of the 375 PICCs, 334 (89%) were ≤4.5 Fr, 342 (91%) were single-lumen, and 366 (98%) were placed using ultrasound guidance. The primary outcome occurred in 15 PICCs for an event rate of 3.11 per 1,000 catheter-days. There were no cases of catheter related bloodstream infection (CRBSI). Other secondary outcomes developed in 147 of 375 (39%) catheters. Despite evidence of practice variation, no risk factors for the primary outcome and few risk factors for secondary outcomes were identified. INTERPRETATION: This study affirms the safety of contemporary approaches to inserting and utilizing PICCs in pwCF. Given the low rate of complications in this study, observations may reflect a widespread shift to selecting smaller-diameter PICC and using ultrasound to guide placement.

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