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Gravdahl E, Haugen DF, Fredheim OM. Use of peripherally inserted central venous catheters and midline catheters for palliative care in patients with cancer: a systematic review. Support Care Cancer 2024; 32:464. [PMID: 38926160 PMCID: PMC11208250 DOI: 10.1007/s00520-024-08664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) and midline catheters (MCs) may offer convenient intravenous access, but evidence to support their place in palliative care is limited. This review aimed to assess catheter indications, utilization, complications, dwell time, and patient experiences in cancer patients receiving palliative care. METHODS A systematic search for studies on catheter utilization for supportive or symptom treatment was conducted in Medline, Embase, CINAHL, Web of Science, Cochrane, and CENTRAL databases. Studies with a study population or a subgroup of palliative care cancer patients were included. Study quality was assessed using the Effective Public Health Practice Quality assessment tool. RESULTS Of 7631 unique titles, 17 articles were examined in detail, all published between 2002 and 2022. Median catheter dwell time varied from 15 to 194 days, the longest when utilized for home parenteral nutrition. For pain and symptom management, the typical duration was 2-4 weeks, often until the patient's death. Complication rates were minimal, with thrombosis, infections, and occlusion ranging from 0 to 2.46 incidents per 1000 catheter days. In studies from palliative care services, patients reported minimal distress during procedures and high user satisfaction. Quality of life assessments post-procedure improved, possibly influenced by concurrent specialist palliative care provision. All studies were assessed to be of moderate or weak quality. CONCLUSION PICC and MC are safe and valuable tools in palliative care cancer patients who would benefit from intravenous access for symptom management. Further studies are needed to clarify indications for PICC or MC in palliative care.
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Affiliation(s)
- Eva Gravdahl
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Olav Magnus Fredheim
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wong CCH, Choi HCW, Lee VHF. Complications of Central Venous Access Devices Used in Palliative Care Settings for Terminally Ill Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4712. [PMID: 37835406 PMCID: PMC10571956 DOI: 10.3390/cancers15194712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Central venous access devices (CVADs) have been commonly employed during various courses of anticancer treatment. Currently, there are a few types of clinically available CVADs, which are associated with short-term and long-term complications. However, little is known about the complication rates when CVADs are used only in palliative care settings. We therefore performed a systematic review and meta-analysis of all the published literature to evaluate the complication rates of CVADs in this clinical setting. (2) Methods: A systematic review and meta-analysis were conducted to identify publications from PubMed/MEDLINE, Embase (Ovid), Scopus, Cochrane Library, CINAHL, Google Scholar, and trial registries. Publications reporting the complication rates of PICCs, central lines, and PORTs in palliative settings for terminally ill cancer patients were included, while those on the use of systemic anticancer therapy and peripheral venous catheters were excluded. The outcome measures included overall complication rate, rate of catheter-related bloodstream infection (CRBSI), and rate of thromboembolism (TE). This systematic review was registered with PROSPERO (CRD42023404489). (3) Results: Five publications with 327 patients were analyzed, including four studies on PICCs and one study on central lines. No studies on PORTs were eligible for analysis. The overall complication rate for PICCs (pooled estimate 7.02%, 95% CI 0.27-19.10) was higher than that for central lines (1.44%, 95% CI 0.30-4.14, p = 0.002). The risk of CRBSI with PICCs (2.03%, 95% CI 0.00-9.62) was also higher than that with central lines (0.96%, 95% CI 0.12-3.41, p = 0.046). PICCs also had a trend of a higher risk of TE (2.10%, 95% CI 0.00-12.22) compared to central lines (0.48%, 95% CI 0.01-2.64, p = 0.061). (4) Conclusions: PICCs for palliative cancer care were found to have greater complications than central lines. This might aid in the formulation of future recommendation guidelines on the choice of CVAD in this setting.
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Affiliation(s)
| | - Horace Cheuk-Wai Choi
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, Centre of Cancer Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Gravdahl E, Steine S, Augestad KM, Fredheim OM. Use and safety of peripherally inserted central catheters and midline catheters in palliative care cancer patients: a retrospective review. Support Care Cancer 2023; 31:580. [PMID: 37725150 PMCID: PMC10509059 DOI: 10.1007/s00520-023-08045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Some cancer patients in palliative care require intravenous administration of symptom relieving drugs. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) provide easy and accessible intravenous access. However, limited evidence supports the use of these devices in palliative care. The aim was to assess the use, safety, and efficacy of PICC and MC in this patient population. METHODS A retrospective study of all palliative care cancer patients who received PICC or MC at the Department of Palliative Medicine at Akershus University Hospital between 2020 and 2022. RESULTS A total of 374 patients were included; 239 patients received a PICC and 135 an MC with a total catheterization duration of 11,698 days. The catheters remained in place until death in 91% of patients, with a median catheter dwell time of 21 days for PICCs and 2 days for MCs. The complication rate was 3.3 per 1000 catheter days, with minor bleeding and accidental dislocation as the most common. The catheters were utilized primarily for opioids and other symptom directed treatments, and 89% of patients received a patient or nurse-controlled analgesia pump. Patients with PICC or MC discharged to home or nursing homes spent 81% of their time out of hospital. CONCLUSION PICC and MC provide safe parenteral access for palliative care cancer patients where intravenous symptom treatment is indicated. Their use can facilitate intravenous symptom treatment beyond the confines of a hospital and supplement the traditional practice relying on subcutaneous administration.
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Affiliation(s)
- Eva Gravdahl
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - Siri Steine
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
| | - Knut Magne Augestad
- Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315, Oslo, Norway
- Department of Gastrointestinal Surgery, Akershus University Hospital, Oslo, Norway
- Department of Surgery, Helgelandssykehuset, Prestmarkveien 1, 8800, Sandnessjøen, Norway
| | - Olav Magnus Fredheim
- Department of Palliative Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315, Oslo, Norway
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Ricou Ríos L, Esposito Català C, Pons Calsapeu A, Adroher Mas C, Andrés Martínez I, Nuño Ruiz I, Castellà Creus M, Castellà Fàbregas L, García Quesada MJ, Estrada Cuxart O, Ara Del Rey J, López Seguí F. Implementation of a vascular access specialist team in a tertiary hospital: a cost-benefit analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:67. [PMID: 37716948 PMCID: PMC10505311 DOI: 10.1186/s12962-023-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/01/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND The use of peripherally inserted central catheters and midline catheters is growing due to their potential benefits. These devices can increase patient safety and satisfaction while reducing the use of resources. As a result, many hospitals are establishing vascular access specialist teams staffed by nurses who are trained in the insertion and maintenance of these catheters. The objective of the study is to evaluate previously to the implementation whether the benefits of introducing ultrasound-guided peripheral venous catheters, midline catheters and peripherally inserted central catheters compared to current practice by a vascular access specialist team outweigh their costs. METHODS Cost-benefit analysis from the perspective of the healthcare provider based on administrative data. The study estimates the reduction in resources used when changing the current practice for the use of ultrasound-guided midline and PICC catheters, as well as the additional resources required for their use. RESULTS The use of an ultrasound-guided device on peripherally inserted central carheter, results in a measurable resource reduction of approximately €31. When 3 peripheral venous catheters are replaced by an ultrasound-guided peripherally inserted central catheter, the saving is €63. Similarly, the use of an ultrasound-guided device on a midline catheter, results in a reduction of €16, while each ultrasound-guided midline catheter replacing 3 peripheral venous catheters results in a reduction of €96. CONCLUSION The benefits of using ultrasound-guided midline and PICC catheters compared to current practice by introducing a vascular access specialist team trained in the implantation of ultrasound-guided catheters, outweigh its cost mainly because of the decrease in hospital stay due to the lowered risk of phebitis. These results motivate the implementation of the service, adding to previous experience suggesting that it is also preferable from the point of view of patient safety and satisfaction.
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Affiliation(s)
- Laura Ricou Ríos
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Barcelona, Spain
| | - Candela Esposito Català
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Arnau Pons Calsapeu
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Cristina Adroher Mas
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Isabel Andrés Martínez
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
| | - Isaac Nuño Ruiz
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
| | - Mònica Castellà Creus
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- Direcció Infermera. Àrea de Qualitat. Gerència Metropolitana Nord, Hospital Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Laia Castellà Fàbregas
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Maria José García Quesada
- Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
- NURECARE-IGTP Nursing Research Group, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Oriol Estrada Cuxart
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Ara Del Rey
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Francesc López Seguí
- Direcció d'Estratègia Assistencial, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain.
- CRES - Centre de Recerca en Economia de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.
- Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Barcelona, Spain.
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BENVENUTI S, PAROLINI F, CERESOLI R, ORIZIO P, ALBERTI D. Technique for replacement of Groshong® peripherally inserted central venous catheters (PICCs) in children. Minerva Pediatr (Torino) 2022; 74:403-407. [DOI: 10.23736/s2724-5276.20.05806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wang X, Lv X, Zhang J, Wang Y. Effect of Chahuang ointment on prevention of phlebitis from peripherally inserted central catheter: randomized clinical trial. Rev Esc Enferm USP 2021; 55:e03680. [PMID: 33729323 DOI: 10.1590/s1980-220x2019008003680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/22/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the effect of Chahuang ointment, a Chinese herbal ointment, on the prevention of phlebitis in patients with peripherally inserted central catheters. METHOD This was a multicenter randomized controlled trial, with 171 eligible patients randomly assigned into one of three groups: the Chahuang ointment group, the Mucopolysaccharide Polysulfate cream group, and the control group. The degrees of vein injuries at 72 hours after peripherally inserted central catheter insertion were the primary outcome. Secondary outcomes were the vascular wall thickness, tissue edema and microthrombus evaluated by Color Doppler Flow Imaging, the vascular endothelial growth factor, and endothelin-1 (ET-1) expression in vivo. RESULTS Compared with the control group, the Chahuang ointment group showed significantly lower incidence of postoperative phlebitis, tissue edema, and microthrombus at 72 hours after peripherally inserted central catheter insertion (all P<0.01). The VEGF and ET-1 expression were significantly inhibited in the Chahuang ointment group after 3 days of treatment (both P<0.01). There were no statistical differences in the degree of vein injuries, microthrombus, or tissue edema between the Chahuang ointment and mucopolysaccharide polysulfate groups (all P>0.05). CONCLUSION Chahuang ointment was shown to provide effective prevention and protection against phlebitis after peripherally inserted central catheter insertion.
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Affiliation(s)
- Xian Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Nursing Department, Shanghai, China
| | - Xiang Lv
- Shanghai University of Traditional Chinese Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Oncology Department, Shanghai, China
| | - Jie Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Nursing Department, Shanghai, China
| | - Yan Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Nursing Department, Shanghai, China
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Arcoverde de Sousa D, Spessoto AB. Peripherally Inserted Central Catheter Versus Central Venous Catheter: It Is Time to Use Different Approaches and Metrics for a More Useful Comparison. Crit Care Med 2021; 49:e109-e110. [PMID: 33337752 DOI: 10.1097/ccm.0000000000004686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Arcoverde de Sousa
- Pediatric Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil
- Pediatric Intensive Care Unit, Instituto da Criança, HCFMUSP, São Paulo, Brazil
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Park EJ, Park K, Kim JJ, Oh SB, Jung KS, Oh SY, Hong YJ, Kim JH, Jang JY, Jeon UB. Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study. Cancer Res Treat 2020; 53:881-888. [PMID: 33355838 PMCID: PMC8291194 DOI: 10.4143/crt.2020.1008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access. Materials and Methods Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death). Results A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, ‘a little comfort’ or ‘much comfort’) compared with the usual IV arm (21%) (p < 0.001). Conclusion Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.
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Affiliation(s)
- Eun Ju Park
- Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Kwonoh Park
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Jae-Joon Kim
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang-Bo Oh
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ki Sun Jung
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - So Yeon Oh
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yun Jeong Hong
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Joo Yeon Jang
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ung-Bae Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Leonardsen AL, Lunde EM, Smith ST, Olsen GL. Patient experiences with peripherally inserted venous catheters- A cross-sectional, multicentre study in Norway. Nurs Open 2020; 7:760-767. [PMID: 32257263 PMCID: PMC7113511 DOI: 10.1002/nop2.448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/03/2020] [Indexed: 11/11/2022] Open
Abstract
Aim To investigate patient experiences with peripherally inserted venous catheters, namely PICC lines and Midlines, as well as the influence of socio-demographic variables, length of stay, comorbidity and complications on these experiences. Design The study had a descriptive, multicentre, cross-sectional design. Methods We used a questionnaire to investigate patient experiences (N = 359). Results Patients experiences were not optimal on each of the items in the questionnaire. Nevertheless, few respondents would have preferred a traditional peripheral venous catheter instead. Moreover, free-text answers indicated that patients were very satisfied with their catheter. Results also indicate that the hospitals have different approach when selecting a PICC line or a Midline as route of choice. The only factor associated with patient experiences was "complications." Conclusion Even though patients reported of several disadvantages with the PICC line/Midline, findings indicate that they would have chosen this again. PICC lines and Midlines are beneficial from the patients' perspective, even though they have disadvantages.
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Nakano Y, Kondo T, Murohara T, Yamauchi K. Option of Using Peripherally Inserted Central Catheters in Elderly Patients With Dementia: An Observational Study. Gerontol Geriatr Med 2020; 6:2333721420906922. [PMID: 32128353 PMCID: PMC7031784 DOI: 10.1177/2333721420906922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Peripherally inserted central catheters (PICCs) facilitate the treatment of several diseases. Here, we assessed the clinical course of elderly patients with dementia using PICCs. Methods: This retrospective observational study was conducted at a single dementia treatment center. PICCs were used in elderly inpatients with dementia who required (a) intravenous therapy, supplemental parenteral nutrition, and dysphagia rehabilitation during acute illness; (b) end-of-life care; (c) total parenteral nutrition (TPN); or (d) an alternative to peripheral vascular (PV) access. Results: Fifty-nine patients were enrolled (83.5 ± 6.9 years): 61% were in the acute treatment group, and 17% were in the end-of-life care group. The median catheter lifespan was 42 (23-87.5) days. The incidence of catheter-related bloodstream infection was 0.22 per 1,000 PICC-days, and that of deep venous thrombosis was 0.66 per 1,000 PICC-days. Among the patients in acute treatment group, 19% resumed sufficient oral intake after the treatment using PICC, and 36% resumed oral intake of gelatin-like food. Among the patients in the end-of-life care group, 91% received intravenous fluids continuously until death by initially inserted PICC. Conclusion: In elderly patients with dementia, PICCs might be one of the options during the treatment of acute illness as well as for prolonged support during end-of-life care.
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Affiliation(s)
- Yoshihisa Nakano
- Toin Hospital, Toin-cho, Japan.,Nagoya University Graduate School of Medicine, Japan
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11
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Simonetti G, Sommariva A, Lusignani M, Anghileri E, Ricci CB, Eoli M, Fittipaldo AV, Gaviani P, Moreschi C, Togni S, Tramacere I, Silvani A. Prospective observational study on the complications and tolerability of a peripherally inserted central catheter (PICC) in neuro-oncological patients. Support Care Cancer 2019; 28:2789-2795. [PMID: 31724074 DOI: 10.1007/s00520-019-05128-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/09/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE The use of central venous catheters with peripheral insertion (PICC) has increased rapidly in recent years, particularly in cancer patients. The benefits provided may occasionally be affected by relevant complications, such as infections and thrombotic events, especially in neuro-oncological patients. To date, the risk of PICC-related complications in this subset of patients is unknown, as is tolerability. As a primary objective, this study aimed to collect complications related to PICCs in primary neuro-oncological patients. As a secondary objective, the study aimed to evaluate PICC tolerability. METHODS Neuro-oncological patients with PICCs that were placed as part of normal clinical practice at IRCCS Neurologico C. Besta were consecutively enrolled in the study. PICC-related complications were recorded immediately (during the procedure), early (within 1 week after PICC insertion), and late (1-3-5 months after PICC placement). At the same time points, all patients were also evaluated for tolerability through interviews with semi-structured, open-ended questions. RESULTS Sixty patients were enrolled (41 males and 19 females, with a median age of 56.2 years). Excluding loss to follow-up, 33/49 patients developed at least one complication related to the PICC. Immediate complications mainly included hematoma (8), accidental arterial puncture (4), and primary malpositioning (3). Regarding early and late complications, 3 device-related infections, 8 thrombotic events, and 20 mechanical complications were registered. Semi-structured interviews revealed an overall positive experience with the device. The most negative impact was on hygiene habits, with 34 patients becoming caregiver-dependent. Over time, almost all patients became used to the device and perceived greater security during chemotherapy. A strongly negative issue was the difficulty of relying on competently trained healthcare personnel in outpatient setting. CONCLUSION The results showed a nonnegligible increased thromboembolic risk in neuro-oncological patients with PICCs, almost double that in historical oncological populations. It is essential to extend the study to a greater number of patients to achieve reliable results and to identify patients at high risk. The device seems to be positively accepted by the majority of patients, without affecting activities of daily living.
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Affiliation(s)
- G Simonetti
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
| | - A Sommariva
- Department of Neuro-anesthesia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - M Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - E Anghileri
- Neurology VIII-Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - C Basso Ricci
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - M Eoli
- Neurology VIII-Molecular Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - A V Fittipaldo
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - P Gaviani
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - C Moreschi
- S.I.T.R.A, Fondazione IRCCS Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - S Togni
- S.I.T.R.A, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - I Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - A Silvani
- Neuro-oncology Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
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What do patients say about their experience with urinary catheters and peripherally inserted central catheters? Am J Infect Control 2019; 47:1130-1134. [PMID: 31324486 DOI: 10.1016/j.ajic.2019.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices. METHODS As part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral. RESULTS Positive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other. CONCLUSIONS Our findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs.
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Magnani C, Calvieri A, Giannarelli D, Espino M, Casale G. Peripherally inserted central catheter, midline, and “short” midline in palliative care: Patient-reported outcome measures to assess impact on quality of care. J Vasc Access 2018; 20:475-481. [DOI: 10.1177/1129729818814732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: A prospective, observational study was conducted in our palliative care unit to assess the impact of peripherally inserted central catheters (PICCs), midline, and “short” midline catheters on the quality of care in cancer and non-cancer patients. The secondary objective was to assess pain and distress during vascular access device insertion. Methods: Patients were recruited if they underwent insertion of a PICC, midline, or “short” midline catheter as part of their standard care. The Palliative care Outcome Scale was used to assess changes in quality of care after vascular access device positioning. A numerical rating scale was used to measure pain intensity during catheter insertion. Results: Of the 90 patients enrolled, 52.2% were male with a mean age of 73.0 ± 13 years. Among these patients, 64.4% patients underwent “short” midline insertion, 26.7% PICC, and 8.9% midline catheter. The patients’ mean baseline Palliative care Outcome Scale score was 15.7 ± 5.6. Three days after vascular access device positioning, the patients’ mean Palliative care Outcome Scale score was 11.5 ± 5.5 (p < 0.0001). Mean pain score during vascular access device insertion was 1.26 ± 1.63, and mean procedural distress score was 1.78 ± 1.93. Conclusion: These findings suggest that medium-term intravenous catheters can have a favorable impact on quality of care and the procedures for these vascular access device insertions are well tolerated. Further research on the performance of different vascular access devices and their appropriateness in palliative care should be encouraged.
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Zuniga KE, Parma DL, Muñoz E, Spaniol M, Wargovich M, Ramirez AG. Dietary intervention among breast cancer survivors increased adherence to a Mediterranean-style, anti-inflammatory dietary pattern: the Rx for Better Breast Health Randomized Controlled Trial. Breast Cancer Res Treat 2018; 173:145-154. [PMID: 30259284 DOI: 10.1007/s10549-018-4982-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The goal of this education and culinary-based dietary intervention was to increase adherence to a Mediterranean-style, anti-inflammatory dietary pattern in breast cancer survivors (BCS) by promoting the consumption of anti-inflammatory foods, herbs, and spices. METHODS Overweight and obese, early-stage, BCS were randomized to the Intervention (n = 76) or Control (n = 77). The 6-month intervention included monthly nutrition and cooking workshops, Motivational Interviewing telephone calls, and individualized newsletters. Control participants received monthly informational brochures and no navigational services. Dietary intakes were collected via questionnaire and 3-day food records at baseline and 6 months. RESULTS One hundred twenty-five BCS (n = 60 I; n = 65 C) completed post-testing (81.7%) and were included in analyses. Adherence to Mediterranean diet guidelines significantly increased in the intervention group, but not in the control group (+ 22.5% vs. + 2.7%, P < 0.001). Upon further analysis of adherence to individual dietary guidelines, the intervention group significantly improved adherence to only three guidelines: consuming ≥ 3 servings of fish or shellfish/week, reducing red meat intake to < 1 serving/day, and limiting consumption of commercial sweets and baked goods to < 3 times/week. The intervention arm increased the use of spices and herbs compared to control (+ 146.2% vs. +33.3%, P < 0.001), including significantly more frequent consumption of cinnamon, turmeric, garlic, ginger, black pepper, and rosemary. CONCLUSION An education and culinary-based intervention in BCS successfully increased adherence to a more Mediterranean-style, anti-inflammatory dietary pattern by increasing the consumption of anti-inflammatory foods, spices, and herbs and decreasing the consumption of pro-inflammatory foods.
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Affiliation(s)
- Krystle E Zuniga
- School of Family and Consumer Sciences, Nutrition and Foods, Texas State University, San Marcos, USA.
| | - Dorothy Long Parma
- Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Edgar Muñoz
- Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Mackenzie Spaniol
- Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Michael Wargovich
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, USA
| | - Amelie G Ramirez
- Department of Epidemiology and Biostatistics, Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
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Use of peripherally inserted central venous catheters (PICCs) in children receiving autologous or allogeneic stem-cell transplantation. J Vasc Access 2018; 19:131-136. [DOI: 10.5301/jva.5000803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: The aim of our study was to present our experience with the use of peripherally inserted central catheters (PICCs) in pediatric patients receiving autologous or allogenic blood stem-cell transplantation. The insertion of the device in older children does not require general anesthesia and does not require a surgical procedure. Methods: From January 2014 to January 2017, 13 PICCs were inserted as a central venous device in 11 pediatric patients submitted to 14 autologous or allogeneic stem-cell transplantation, at the Bone Marrow Transplant Unit of the Children’s Hospital of Brescia. The mean age of patients at the time of the procedure was 11.3 years (range 3-18 years). PICCs remained in place for an overall period of 4104 days. All PICCs were positioned by the same specifically trained physician and utilized by nurses of our stem-cell transplant unit. Results: No insertion-related complications were observed. Late complications were catheter ruptures and line occlusions (1.2 per 1000 PICC days). No rupture or occlusion required removal of the device. No catheter-related venous thrombosis, catheter-related bloodstream infection (CRBSI), accidental removal or permanent lumen occlusion were observed. Indications for catheter removal were completion of therapy (8 patients) and death (2 patients). Three PICCs are currently being used for blood sampling in follow-up patients after transplantation. Conclusions: Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in pediatric patients with high risk of infectious and hemorrhagic complications such as patients receiving stem-cell transplantation.
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Central venous pressure monitoring via peripherally or centrally inserted central catheters: a systematic review and meta-analysis. J Vasc Access 2017; 18:273-278. [PMID: 28665469 DOI: 10.5301/jva.5000749] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The central venous pressure (CVP) is the most commonly used static marker of preload for guiding fluid therapy in critically ill patients, though its usefulness remains controversial. Centrally inserted central catheters (CICCs) are the gold-standard devices for CVP monitoring but peripherally inserted central catheters (PICCs) may represent a valid alternative. We undertook a systematic review and meta-analysis with the aim to investigate whether the difference between PICC- and CICC-measured CVP is not significant. METHODS We searched for clinical studies published in PubMed and EMBASE databases from inception until December 21st 2016. We included studies providing data on paired and simultaneous CVP measurement from PICCs and CICCs. We conducted two analyses on the values of CVP, the first one according to the total number of CVP assessments, the second one considering the number of patients recruited. RESULTS Four studies matched the inclusion criteria, but only three of them provided data for the meta-analyses. Both analyses showed non-significant differences between PICC-measured and CICC-measured CVP: 1489 paired simultaneous CVP assessments (MD 0.16, 95%CI -0.14, 0.45, p = 0.30) on a total of 57 patients (MD 0.22, 95%CI -1.46, 1.91, p = 0.80). Both analyses showed no heterogeneity (I2 = 0%). CONCLUSIONS Available evidence supports that CVP monitoring with PICCs is accurate and reproduces similar values to those obtained from CICCs. The possibility to monitor CVP should not be used among clinical criteria for preferring a CICC over a PICC line.
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