JPEN J Parenter Enteral Nutr. 2013 May-Jun;37(3):375-83.

Catheter-Related Complications in Cancer Patients on Home Parenteral Nutrition: A Prospective Study of Over 51,000 Catheter Days

Paolo Cotogni, MD; Mauro Pittiruti, MD; Cristina Barbero, MD; Taira Monge, RD; Augusta Palmo, MD; and Daniela Boggio Bertinet, MD

Paolo Cotogni, MD, Consultant anesthesiologist, Department of Medicine, Head Unit of Parenteral Nutrition in Oncology, S. Giovanni Battista Hospital, University of Turin, Via Giovanni Giolitti 9, 10123 Turin, Italy. Email: paolo.cotogni@unito.it.

 

ABSTRACT:

Background: Although home parenteral nutrition (HPN) is often indicated in cancer patients, many physicians are concerned about the risks potentially associated with the use of central venous access devices (VADs) in these patients. The aim of this prospective study was to investigate the actual incidence of VAD-related complications in cancer patients on HPN.

Methods: All adult can cer patient candidates for VAD insertion and HPN were enrolled. The incidence of complications associated with 4 types of VADs (peripherally inserted central catheter [PICC], Hohn catheter, tunneled Groshong catheter, and port) was investigated, as well as the most significant risk factors.

Results: Two hundred eighty-nine VADs in 254 patients were studied, for a total of 51,308 catheter-days. The incidence of catheter-related bloodstream infections (CRBSIs) was low (0.35/1000 catheter-days), particularly for PICCs (0/1000; P < .01 vs Hohn and tunnelled catheters) and for ports (0.19/1000; P < .01 vs Hohn and P < .05 vs tunneled catheters). Mechanical complications were uncommon (0.8/1000), as was VAD-related venous thrombosis (0.06/1000). Ultrasound-guided venipuncture was associated with a decreased risk of CRBSI (P < .04) and thrombosis (P < .001). VAD securement using sutureless devices reduced the risk of CRBSI and dislocation (P < .001). Hohn catheters had no advantage over PICCs (higher complication rate and shorter dwell time; P < .001).

Conclusions: In cancer patients, HPN can be safely carried out with a low incidence of complications. Also, VADs are not equal in terms of complication rates, and strict adherence to meticulous insertion policies may effectively reduce catheter-related complications.

PMID: 23002096

 

SUPPLEMENT:

Long-term venous access devices (VADs) are increasingly needed for cancer patient care because the emphasis shifted to the outpatient scenario. All healthcare professionals involved in the choice, insertion or management of VADs in these patients should know pro and cons of all VADs.

This is a prospective, observational study evaluating the incidence of catheter related complications (CRCs) in a diverse group of oncology patients receiving home parenteral nutrition (HPN). 289 VADs were placed in 254 patients over the study period – 4 different types of VADs were used – peripherally inserted central catheters (PICCs), Hohn, port, and tunneled catheters.

Overall the risks of CRCs in this cancer patient population regardless of the VAD used were low (a credit to the team and protocols utilized); however, there were certain factors (eg, no ultrasound-guidance during venipuncture, VAD securement to the skin by suture) that seemed to increase the risk of complication, particularly when the Hohn catheter was used.

On the contrary, this study demonstrated that PICCs can be safely used for HPN and chemotherapy in cancer outpatients with a low incidence of catheter-related bloodstream infections (CRBSIs), thrombosis, and mechanical complications (overall complications: 0.96 episodes/1000 catheter-days).

These findings are clinically relevant for guiding physicians in the proper choice of a long-term VAD in cancer patients.

Contact Information:

Paolo Cotogni, MD; paolo.cotogni@unito.it
WBF2014-Figure-1Fig 1: Probability of a catheter-related bloodstream infection after insertion of different types of a central venous access device (VAD). PICC, peripherally inserted central catheter; H, Hohn; T, tunneled.

Paolo, Cotogni

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