(576) Safety of Non-cuffed Tunneled Small-bore Central Venous Catheters in Adults with Cystic Fibrosis

Background: Peripherally inserted central catheters (PICCs) are the most common route of intravenous (IV) access for treatment of cystic fibrosis (CF) pulmonary exacerbations. Repeated PICC placement can result in peripheral venous stenosis precluding placement of a PICC. Once peripheral stenosis develops, a non-cuffed small-bore central venous catheter (CVC), which is tunneled before insertion into the more central internal jugular vein, is an alternative route for IV access. While non-cuffed small-bore CVC are regularly used at some CF centers, the safety and complication rate of tunneled non-cuffed small-bore CVCs as compared to PICCs in adults with cystic fibrosis has not been reported. This study aims to describe the safety of tunneled non-cuffed small-bore CVCs in adults with CF.

Methods: The adult CF program at University of Kansas Medical Center cares for more than 270 adult patients with CF. A retrospective cohort study was performed which included adults (18 years or older) with confirmed diagnosis of CF who received tunneled non-cuffed small-bore CVCs in interventional radiology from 7/19/2007-3/09/2020. The electronic medical record (EMR), EMR-integrated databases, and Picture Archiving and Communications Systems (PACS) were used to identify patients who met inclusion criteria. Complications related to tunneled non-cuffed CVCs which were analyzed included catheter related deep venous thrombosis (DVT), central line associated blood stream infection (CLABSI), and catheter related central venous stenosis. Complications were considered attributable if they occurred while the line was in place or within 30 days of line removal.

Results: There were 386 tunneled non-cuffed CVCs placed in 60 patients (55% females) with a mean of 6.4 lines per patient. The average age at placement of the first tunneled non-cuffed CVC was 28.3 years. The average duration of indwelling tunneled non-cuffed CVC was 16.2 days. Catheters were categorized in terms of size in French (Fr): unknown n=53, 4 Fr n=237, 5 Fr n=81, and 6 Fr n=15. No patients demonstrated catheter attributable DVT. There were 4 attributable CLABSI complications: unknown n=1 (1.9%), 4 Fr n=0 (0%), 5 Fr n=2 (2.5%), and 6 Fr n=1 (6.7%). Case review demonstrated that 3 of 4 cases of CLABSI occurred in patients with a documented history of tampering with their CVC. There was one catheter attributable central venous stenosis in the 4 Fr catheter size. The incidence of DVT, CLABSI, and central venous stenosis attributable to indwelling tunneled non-cuffed CVCs was 0 (0%), 4 (1%), and 1 (0.3%), respectively.

Conclusions: Historically, many adults with CF have required numerous PICCs placed over their lifetime for the treatment of recurrent pulmonary exacerbations. In those adults that develop PICC associated peripheral vein stenosis, our results indicate tunneled non-cuffed CVCs are a safe alternative with low complication rate.

Acknowledgements:

References: