A comparative study of peripherally-inserted and Broviac catheter complications in home parenteral nutrition patients.
OBJECTIVE
Peripherally inserted central venous catheters (PICC) have become increasingly popular for medium to long-term parenteral nutrition (PN) but there is limited data on the complication rates in this sub-group. We aimed to compare the rates of complications associated with tunneled catheters (Broviac) and PICC in home PN (HPN) patients.


METHODS
All adult patients in an HPN program with a new Broviac or new PICC between 2009 and 2011 were included in this prospective observational study. Complication rates were compared by using Poisson regression and Kaplan Meier survival curves were used to compare the first complications that occurred.


RESULTS
204 catheters (133 Broviac and 71 PICC) were inserted in 196 adult patients. Mean follow-up from catheter insertions to their removal was 276 ± 219 days for Broviac (n = 86) vs. 74 ± 140.70 days for PICC (n = 56); p < 0.001. Complications were similar between Broviac and PICC (91/133 vs. 26/71). Catheter infection rate was lower in PICC (1.87 vs. 1.05 per 1000 catheter-days; p = 0.01). Catheter obstruction rates were similar for both catheters. Only PICC experienced venous thrombosis (0.4/1000). The proportion of catheters removed was lower in the Broviac group than in the PICC group (62.4% vs. 78.8%; p = 0.01) but those removed for complications were not different (28.6.7%vs. 25.3%; p = 0.64).


CONCLUSIONS
In HPN patients, overall complications were similar in both the PICC and the Broviac groups. However, the Broviac catheter could be associated with an increase in catheter infection.
Approved Centre for Home Parenteral Nutrition in Adults in Lyon, Hospices Civils of Lyon, France.
A
A
Touré
Transversal Unit of Clinical Nutrition, Hospices Civils of Lyon, France.
A
A
Duchamp
Approved Centre for Home Parenteral Nutrition in Adults in Lyon, Hospices Civils of Lyon, France.
C
C
Peraldi
Transversal Unit of Clinical Nutrition, Hospices Civils of Lyon, France.
D
D
Barnoud
Approved Centre for Home Parenteral Nutrition in Adults in Lyon, Hospices Civils of Lyon, France.
M
M
Lauverjat
Approved Centre for Home Parenteral Nutrition in Adults in Lyon, Hospices Civils of Lyon, France.
P
P
Gelas
Approved Centre for Home Parenteral Nutrition in Adults in Lyon, Hospices Civils of Lyon, France; Transversal Unit of Clinical Nutrition, Hospices Civils of Lyon, France. Electronic address: cecile.chambrier@chu-lyon.fr.
C
C
Chambrier
D000368:Aged; D061807:Catheter Obstruction / Q000706:statistics & numerical data; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D057785:Catheters / Q000009:adverse effects*; D062905:Central Venous Catheters; D006801:Humans; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000295:instrumentation*; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000453:epidemiology
Complication; Home parenteral nutrition; Peripherally inserted central venous catheters; Sepsis; Thrombosis; Tunneled catheter