Complications and Practice Variation in the Use of Peripherally Inserted Central Venous Catheters in People With Cystic Fibrosis: The Prospective Study of Peripherally Inserted Venous Catheters in People With Cystic Fibrosis Study

Alex H Gifford; Alexandra C Hinton; Shijing Jia; Samya Z Nasr; Joel D Mermis; Thomas Lahiri; Edith T Zemanick; Charlotte C Teneback; Patrick A Flume; Emily A DiMango; Hossein Sadeghi; Deepika Polineni; Rebecca H Dezube; Natalie E West; Elliott C Dasenbrook; F Lee Lucas; Jonathan B Zuckerman

doi:10.1016/j.chest.2023.03.043

Complications and Practice Variation in the Use of Peripherally Inserted Central Venous Catheters in People With Cystic Fibrosis: The Prospective Study of Peripherally Inserted Venous Catheters in People With Cystic Fibrosis Study

Chest. 2023 Sep;164(3):614-624. doi: 10.1016/j.chest.2023.03.043. Epub 2023 Apr 3.

Authors

Alex H Gifford¹, Alexandra C Hinton², Shijing Jia³, Samya Z Nasr³, Joel D Mermis⁴, Thomas Lahiri⁵, Edith T Zemanick⁶, Charlotte C Teneback⁵, Patrick A Flume⁷, Emily A DiMango⁸, Hossein Sadeghi⁹, Deepika Polineni¹⁰, Rebecca H Dezube¹¹, Natalie E West¹¹, Elliott C Dasenbrook¹², F Lee Lucas², Jonathan B Zuckerman¹³

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Pulmonology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
² Maine Medical Center Research Institute, Scarborough, ME.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The University of Kansas Health System, Kansas City, KS.
⁵ Division of Pediatric Pulmonology, Department of Pediatrics, University of Vermont Children's Hospital, Division of Pulmonary Disease & Critical Care Medicine, Department of Medicine, the University of Vermont Medical Center, Burlington, VT.
⁶ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO.
⁷ Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.
⁸ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and the Vagelos College of Physicians and Surgeons, Columbia University, New York, NY.
⁹ Department of Pediatrics, Columbia University Medical Center, New York, NY.
¹⁰ Division of Pulmonary, Critical Care and Sleep Medicine, Washington University at St. Louis, St. Louis, MO.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD.
¹² Respiratory Institute, Cleveland Clinic, Cleveland, OH.
¹³ Maine Medical Center Research Institute, Scarborough, ME; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Maine Medical Center, Portland, ME. Electronic address: Jzuckerman@cmamaine.com.

PMID: 37019356
PMCID: PMC10504599 (available on 2024-09-01)
DOI: 10.1016/j.chest.2023.03.043

Abstract

Background: Peripherally inserted central catheters (PICCs) are used commonly to administer antibiotics to people with cystic fibrosis (CF), 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 people with CF?

Study design and methods: This was a prospective observational study of adults and children with CF who received PICCs at 10 CF care centers in the United States. The primary end point was defined as occlusion of the catheter resulting in unplanned removal, symptomatic venous thrombosis in the extremity containing the catheter, or both. Three categories of composite secondary outcomes were identified: 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 logistic regression.

Results: Between June 2018 and July 2021, 157 adults and 103 children older than 6 years with CF had 375 PICCs placed. Patients underwent 4,828 catheter-days of observation. Of the 375 PICCs, 334 (89%) were ≤ 4.5 F, 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. No cases of catheter-related bloodstream infection occurred. Other secondary outcomes developed in 147 of 375 catheters (39%). Despite evidence of practice variation, no risk factors for the primary outcome and few risk factors for secondary outcomes were identified.

Interpretation: This study affirmed the safety of contemporary approaches to inserting and using PICCs in people with CF. Given the low rate of complications in this study, observations may reflect a widespread shift to selecting smaller-diameter PICCs and using ultrasound to guide their placement.

Keywords: DVT; PICC; complications; cystic fibrosis; peripherally inserted central catheters; phlebitis.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Catheter-Related Infections* / epidemiology
Catheter-Related Infections* / etiology
Catheterization, Central Venous* / adverse effects
Catheterization, Central Venous* / methods
Catheterization, Peripheral* / adverse effects
Catheters, Indwelling
Central Venous Catheters*
Child
Cystic Fibrosis* / complications
Cystic Fibrosis* / therapy
Humans
Prospective Studies
Retrospective Studies
Venous Thrombosis* / etiology

Grants and funding

U54 GM115516/GM/NIGMS NIH HHS/United States