Peripherally inserted central catheters for parenteral nutrition: a comparison with centrally inserted catheters

Area of Science:

• Vascular Access Devices
• Parenteral Nutrition
• Clinical Practice Trends

Background:

• Central venous access is essential for parenteral nutrition (PN).
• The choice of central venous access device (CVAD) for PN has shifted significantly over the last decade.
• Peripherally inserted central catheters (PICCs) have emerged as a popular CVAD without prior controlled trials.

Purpose of the Study:

• To analyze the evolution of CVADs used for PN over a 10-year period.
• To compare the incidence of major complications (thrombosis, line sepsis) among different CVAD types.
• To specifically compare complications associated with PICCs versus other central venous catheters.

Main Methods:

• Prospective data collection on CVADs for PN over 10 years at a single institution.
• Analysis of CVAD types used across three distinct time periods (1988-1989, 1992-1993, 1996-1997).
• Comparative analysis of complications, including thrombosis and sepsis, between PICCs and non-PICC CVADs.

Main Results:

• PICC utilization increased, becoming dominant by 1996-1997 (48%), surpassing tunneled and nontunneled catheters.
• The period 1996-1997 saw decreased sepsis and pneumothorax but increased severed/leaking catheters and phlebitis.
• Compared to non-PICCs, PICCs showed a trend toward decreased sepsis but increased malposition, inadvertent removal, and severed/leaking catheters.

Conclusions:

• PICCs have largely replaced tunneled and nontunneled central catheters for PN delivery.
• PICCs are associated with similar rates of line sepsis and thrombosis compared to other CVADs.
• PICCs demonstrate a higher incidence of local complications, including leaking, phlebitis, and malposition.