Abstract

Abstract 3161

Purpose:

Patients with haematological disorders frequently require the insertion of medium or long-term central venous catheters (CVCs) for stem-cell transplantation, the administration of chemotherapy, or transfusions. Although peripherally inserted central catheters (PICCs) have been in use for many years, little data exist on their use in patients receiving intensive chemotherapy and blood progenitor cell transplantation.

Methods:

Evidence-based interventions were implemented in our department from November 2009 to July 2012, and include: 1.An high level nurse education program for correct practices and prevention of catheter-associated complications. was developed for PICC nursing team; 2) The use of ultrasound guide for the insertion of the tip of PICCs, thanks to a special operator training; 3) Bedside placement and confirmed PICC tip placement by chest radiography after removal of the guidewire and before the securing of the catheter; 4) Maintenance of maximum sterile barrier precautions during PICC insertion and aftercare; 5) chlorhexidine preparation, replace 10% povidone iodine for skin antisepsis; 6) adoption of PICC patient nurse archive, including the information of weekly PICC line review at our department for each patient.

Aim:

Here, we carried out a clinical prospective investigation to determine the efficacy of these interventions in reducing the rate of PICC-related complications (thrombotic events, exit site infection and other complications requiring early removal of PICCs); the studied population included hematology patients receiving intensive chemotherapy compared to allogeneic/autologous stem cell transplant recipients.

Results:

Three hundred sixty-four (364) PICCs were in place in 299 patients for a total of 41.111 PICC days ( range, 1–482 days; mean 112,94 days); 292 were inserted in patients receiving conventional chemotherapies, and 72 in patients undergoing allogeneic or autologous hematopoietic stem cell transplantation (SCT). Sixty-six (60) PICCs were inserted during severe thrombocytopenia (platelets < 50 × 10(9)/L), seventy (70) during severe neutropenia (neutrophils < 0.5 × 10(9)/L) and thirty-eight (38) during antithrombotic prophylaxis. Predominantly, patients had Lymphoma (50%). The rate of major complication was very low: 15 thrombotic complications PICC-related (4%; 0.36 per 1,000 CVC days), and 3 CRBSI (0,8%; 0.07 per 1,000 CVC days) during neutropenia. Mechanical complications occurred in 52 catheters, and were accidental dislodgement (30), catheter break (3), catheter inadequate (19); other reasons for catheter removal were completion of therapy (137), lumen occlusion (19) and death (58). Interesting, taking in account the underlying disease, lymphoma and leukemia patients have, respectively, an increased risk of developing a CRBSI and a thrombotic PICCs-complication when submitted to hematopoietic stem cell transplantation (SCT) (see table 1). However, compared with allogeneic/autologous stem cell transplant group, the intensive chemotherapy group was associated with a marginally lower incidence of CRBSI complication rate (0.6 % vs 1.0 %, 0.10 vs 0.60 per 1,000 CVC days) [odds ratio (OR) 2,042]; no relevant differences in terms of thrombotic complications between the two cohorts (4.11 % vs 4.17%), 0.29 vs 0.39 per 1,000 CVC days) [odds ratio (OR) 1.014].

Conclusions:

Our findings suggest, therefore, PICC devices are a viable and safe option for management of the haematology patients receiving intensive chemotherapy and even in patients particularly prone to infective and thrombotic complications such as patients receiving blood stem cell transplantation.

Table 1.

Outcomes according to underlying disease and relative adhibition

DiagnosisChemotherapyASCTStatisticsOdds Ratio
% Definite CRBSI% Thrombosis% Definite CRBSI% ThrombosisDefinite CRBSI (%)Definite CRBSI per 1000 PICC daysTrombosis (%)Trombosis per 1000 PICC daysRange (days)Means (days)OR CRBSIOR Thrombosis
Lymphoma (n. 182) 0.69 4.16 2.63 2.63 1.10 0.10 3.85 0.34 4–336 146.3 3.86 0.62 
Acute Leukemia (n 120)) 0.95 4.76 13.33 0.83 0.07 5.83 0.46 99–432 213.8 3.07 
Others (n. 62) 2.32 0.00 1.61 0.19 6-287 79.2 
Overall 0.68 4.11 1.39 4.17 0.82 0.07 4.12 0.36 0–482 112.94 2.042 1.014 
DiagnosisChemotherapyASCTStatisticsOdds Ratio
% Definite CRBSI% Thrombosis% Definite CRBSI% ThrombosisDefinite CRBSI (%)Definite CRBSI per 1000 PICC daysTrombosis (%)Trombosis per 1000 PICC daysRange (days)Means (days)OR CRBSIOR Thrombosis
Lymphoma (n. 182) 0.69 4.16 2.63 2.63 1.10 0.10 3.85 0.34 4–336 146.3 3.86 0.62 
Acute Leukemia (n 120)) 0.95 4.76 13.33 0.83 0.07 5.83 0.46 99–432 213.8 3.07 
Others (n. 62) 2.32 0.00 1.61 0.19 6-287 79.2 
Overall 0.68 4.11 1.39 4.17 0.82 0.07 4.12 0.36 0–482 112.94 2.042 1.014 

CRBSI catheter-related bloodstream infection. PICC peripherally inserted CVC. ASCT allogeneic/autologous stem cell transplant

Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.