(28) A MULTI-CENTER STUDY of PERIPHERALLY INSERTED CENTRAL VENOUS CATHETERS (PICC-CF): PREDICTORS of DIFFICULT LINE INSERTION, MALFUNCTION and SOFT TISSUE INJURY

Background: People with CF (PwCF) may have peripherally inserted central venous catheters (PICC) placed for administration of intravenous antibiotics. Little has been published about factors associated with problematic line placement, subsequent catheter malfunction and local soft tissue reactions in this population. Here, we present data from PICC-CF, a prospective study of PICC practice patterns and complications in adult and pediatric PwCF at 10 U.S. centers.

Methods: Eligible PwCF were > 6 years of age undergoing treatment via hospital-placed PICC. Exclusion criteria included: use of a totally implanted vascular access device or peripheral line for the full course of therapy or anticoagulant medication at the time of line insertion. We collected clinical and demographic data prior to catheter insertion. We made detailed assessments of line insertion, management, and subsequent function along with patient signs/symptoms related to the indwelling catheter every 2-4 days until line removal. We used logistic regression models to evaluate the association between patient and catheter characteristics and line placement, subsequent catheter malfunction, and local soft tissue reactions. Analyses were conducted separately for adult and pediatric patients where appropriate. Analyses of catheter malfunction and local soft tissue reactions were adjusted for length of treatment. Analyses of outcomes in pediatric patients were additionally adjusted for the patients’ age. P value of < 0.01 was considered significant in the context of multiple comparisons.

Results: We screened 429 and enrolled 260 patients, comprising 4,705 catheter-days for 375 lines. Study population statistics: females 123 (47%); median age 20 years (IQR 13, 28); children 93 (39%); Catheter attributes: single lumen 342 (91%); < 5 Fr 334 (89%); venue of line placement: bedside 90 (24%); dedicated vascular access suite 76 (20%); interventional radiology 209 (56%).
Management/Outcomes: Despite a low frequency of blood stream infections (0%) and venous thrombosis (1.6%), less serious adverse events were noted in 147 cases (39%). In 24 cases (6.4%) line placement was problematic, usually due to difficult guidewire advancement (22/24). We found no significant predictors of difficult line placement. Local soft tissue reactions were noted in 94 (25%) with proportions similar in adults and children, though reactions leading to line removal tended to be more frequent in adults (5.5% vs 1.4%, p=0.052). Predictors of local reactions included increased catheter size (OR 3.85, 95%CI 1.53, 10.44, p=0.006 for 4 Fr vs. 3 Fr and OR 4.53, 95%CI 1.44, 14.72, p=0.010 for 4.5 Fr vs. 3 Fr) in children and multi-lumen catheter use (OR 3.11, 95%CI 1.32, 7.24, p=0.008) in adults. Catheter malfunction was observed in 59 cases (16%) and resulted in line removal in 10 cases (2.7%), both in similar proportions of adults and children. Predictors of catheter malfunction in adults included the following: history of difficult wire passage (OR 6.09, 95%CI 2.33, 15.7, p=< 0.001) and venous stenosis or anatomy preventing access on one side (OR 6.91, 95%CI 2.02, 23.8, p=0.002). Adverse events other than venous thrombosis led to early line removal in 11 cases (2.9%).

Conclusions: Despite practice variation across sites, there were only rare instances of venous thrombosis. However, we identified a number of factors predictive of catheter malfunction and soft tissue reactions.

Acknowledgements: This work was supported by CFF [ZUCKER18A0]

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