Role of peripherally inserted central catheters in home parenteral nutrition: a 5-year prospective study.
BACKGROUND
Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being preferred for its administration. Peripherally inserted central catheters (PICCs) are not currently recommended for long-term HPN, although evidence to support this statement is scarce. The authors aimed to evaluate the outcomes of HPN, focusing on CVC-related complications.


METHODS
All patients attended at the authors' center for HPN from 2007-2011 were prospectively included. HPN composition aimed at 20-35 kcal/kg/d, 3-6 g/kg/d of glucose, 1.0 g/kg/d of amino acids, and <1 g/kg/d of lipids. HPN was infused in an intermittent schedule, mostly at night. Catheter-related bloodstream infections (CRBSIs) were confirmed with positive semi-quantitative or quantitative culture of the catheter or simultaneous differential blood cultures drawn through the CVC and peripheral vein.


RESULTS
Seventy-two patients received HPN, with 79 implanted CVCs (48 PICCs, 10 Hickman, and 21 ports). Mean catheter-days were 129.1 for PICCs, 98.5 for Hickman, and 67.7 for ports (P = .685). When analyzing CRBSIs, ports had 44, Hickman had 20, and PICC had 0 episodes per 1000 catheter-days (P = .078). Only PICCs showed less incidence of CRBSIs vs ports (P = .043). Multivariate logistic regression, correcting by catheter-days, patients' age and sex, underlying disease, and type of catheter, showed that only catheter-days (P = .031) was a predictor for CRBSIs (P = .007, Nagelkerke R= = 0.246).


CONCLUSIONS
PICCs are similar in terms of catheter-related complications to other CVCs for the administration of HPN, especially for oncology patients with HPN lasting <6 months.
Unit of Clinical Nutrition and Obesity, Department of Endocrinology and Nutrition, Madrid, Spain. jbotella.hrc@salud.madrid.org
Jose I
JI
Botella-Carretero
Carmen
C
Carrero
Eva
E
Guerra
Beatriz
B
Valbuena
Francisco
F
Arrieta
Alfonso
A
Calañas
Isabel
I
Zamarrón
Jose A
JA
Balsa
Clotilde
C
Vázquez
D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D011446:Prospective Studies