Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.
Department of Anesthesia and Intensive Care Medicine, Ryhov County Hospital, Jonkoping, Sweden.
Cancer. 2022 Oct;128(20):3681-3690. doi: 10.1002/cncr.34410. Epub 2022 Aug 9.
The risk of peripherally inserted central catheter (PICC)-related complications in patients hospitalized with solid tumors remains unclear. Existing studies are limited by single-center, outpatient designs and include heterogenous patients.
A retrospective cohort study was designed and included adult patients with solid organ cancers who were admitted to a general medicine ward or intensive care unit and received a PICC. Data were collected from November 2013 to December 2019 at 50 Michigan hospitals. Major complications were defined as central line-associated bloodstream infection, deep vein thrombosis, pulmonary embolism, and catheter occlusion. Hospital variation in PICC use and outcomes was examined.
Data included 3235 hospitalized patients with solid tumors who had PICCs placed for 51,047 catheter days. Most catheters were double-lumen devices (57.0%). Notably, 17.5% of patients had another central venous catheter at the time of PICC insertion. The most common indications for PICC use were antibiotics (34.5%) and difficult access or blood draws (21.6%); chemotherapy was the primary indication in only 15.7% of patients. A major PICC-related complication occurred in 491 patients (15.2%); catheter occlusion was the most prevalent complication (n = 322; 10.0%) followed by deep vein thrombosis (n = 116; 3.6%), central line-associated bloodstream infection (n = 82; 2.5%), and pulmonary embolism (n = 20; 0.6%). Significant variation in indications for PICC use, device characteristics, and frequency of major complications across hospitals was observed (p < .001).
PICCs were associated with significant complications in hospitalized patients who had solid malignancies and were often used for reasons other than chemotherapy. Policies and guidance for the appropriate use of PICCs in oncologic patients appear necessary.
Peripherally inserted central catheters (PICCs) are devices placed in peripheral veins to deliver medication to large veins near the heart. PICCs are used frequently in oncology. The objective of this report was to describe PICC-associated complications in hospitalized patients with solid tumors. This study was performed across 50 Michigan hospitals and included 3235 patients with solid tumor cancers and who had a PICC. Overall, 15.2% of patients experienced a complication, including central line-associated bloodstream infections, deep vein thrombosis, pulmonary embolism, or catheter occlusion. Complication rates varied across hospitals. PICCs are associated with substantial complications in hospitalized patients with solid tumors.
在因实体瘤住院的患者中，经外周静脉穿刺中心静脉置管（PICC）相关并发症的风险尚不清楚。现有研究的局限性在于单中心、门诊设计，并纳入了异质性患者。
设计了一项回顾性队列研究，纳入了在普通医学病房或重症监护病房接受 PICC 的成年实体器官癌患者。数据于 2013 年 11 月至 2019 年 12 月在密歇根州的 50 家医院收集。主要并发症定义为中心静脉导管相关血流感染、深静脉血栓形成、肺栓塞和导管阻塞。检查了 PICC 使用和结果的医院差异。
数据包括 3235 名因实体瘤住院且接受 51047 天 PICC 置管的患者。大多数导管为双腔装置（57.0%）。值得注意的是，17.5%的患者在 PICC 置入时还有另一个中心静脉导管。PICC 使用的主要适应证是抗生素（34.5%）和难以进入或采血（21.6%）；仅 15.7%的患者主要适应证是化疗。491 名患者（15.2%）发生重大 PICC 相关并发症；导管阻塞是最常见的并发症（n=322；10.0%），其次是深静脉血栓形成（n=116；3.6%）、中心静脉导管相关血流感染（n=82；2.5%）和肺栓塞（n=20；0.6%）。观察到医院之间 PICC 使用、器械特征和重大并发症频率的适应证存在显著差异（p<.001）。
PICC 在患有实体恶性肿瘤的住院患者中会引起严重并发症，且通常用于化疗以外的其他原因。似乎有必要制定用于肿瘤患者的 PICC 合理使用政策和指南。
经外周静脉穿刺中心静脉置管（PICC）是一种将导管插入外周静脉以将药物输送到靠近心脏的大静脉的装置。PICC 在肿瘤学中经常使用。本报告的目的是描述接受 PICC 治疗的住院实体瘤患者的 PICC 相关并发症。该研究在密歇根州的 50 家医院进行，共纳入 3235 名患有实体瘤癌症且接受 PICC 治疗的患者。总体而言，15.2%的患者发生了并发症，包括中心静脉导管相关血流感染、深静脉血栓形成、肺栓塞或导管阻塞。并发症发生率在各医院之间存在差异。PICC 在患有实体肿瘤的住院患者中会引起严重并发症。
