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Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central
Craig McManus1, Nicholas Mifflin1, Renz Rivera2
1Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia.
Insights
Tunnelled femorally inserted central catheters (tFICC) showed similar catheter-related outcomes compared to peripherally inserted central catheters (PICC). This suggests tFICCs are a viable alternative for vascular access when upper extremity or thoracic veins are unsuitable.
Area of Science:
- Vascular Access
- Infectious Diseases
- Medical Devices
Background:
- Central venous access devices (CVADs) are crucial for long-term therapies.
- Peripherally inserted central catheters (PICCs) are commonly used but can have limitations.
- Tunnelled femorally inserted central catheters (tFICCs) offer an alternative route for central venous access.
Purpose of the Study:
- To compare catheter-related outcomes between tFICC and PICC.
- To evaluate the safety and efficacy of tFICCs as an alternative to PICCs.
- To assess differences in catheter failure, infection, dwell time, and deep vein thrombosis (DVT).
Main Methods:
- A propensity-score matched cohort study was conducted.
- In-patients requiring central venous access were included.
- Catheter failure, infection, dwell, and DVT rates were compared between tFICC and PICC groups.
Main Results:
- No significant differences were observed in all-cause catheter failure rates between tFICC and PICC groups.
- Catheter dwell time and the probability of failure within the first month did not differ significantly.
- Rates of catheter removal due to infection and confirmed catheter-related DVT were similar for both catheter types.
Conclusions:
- tFICCs demonstrate comparable catheter-related outcomes to PICCs.
- tFICCs represent a safe and effective alternative for vascular access.
- Consider tFICCs when upper extremity or thoracic veins are not suitable for catheterization.
Objectives:
To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities.
Design:
A propensity-score matched cohort study.
Setting:
A 980-bed tertiary referral hospital in South West Sydney, Australia.
Participants:
In-patients referred to the hospital central venous access service for the insertion of a central venous access device.
Primary And Secondary Outcome Measures:
The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT).
Results:
The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference -0.63/1000 catheter days, 95% CI -2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI -6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI -0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference -0.11 per 1000 catheter days, 95% CI -0.26 to 0.04, p=1.00).
Conclusion:
There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.
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