Peripherally inserted central venous catethers in the management of autologous haematopoietic stem cell transplantation

Patients (pts) undergoing haematopoietic stem cell transplantation (HSCT) require a reliable venous access. Peripherally inserted central venous catheters (PICC) offer certain advantages over other forms of long-term venous central access. They are inserted via peripheral veins such as cephalic, basilic or brachial vein without general anaesthetic or sedation and a surgical procedure is not required. The risk of pneumothorax and haemothorax from PICC insertion is minimal. They are also easy to remove and less expensive than central venous catheters. A total of 24 PICC lines (single-lumen silicone catheter with Groshong valve, 4 Frx60cm, 18Ga.lumen) were inserted between May and November 2008 by expert surgeon under ultrasound guidance bedside in 24 pts, undergoing high dose chemotherapy followed by autologous SCT for onco-haematological malignancies. Pts' characteristics were: M/F 15/8, median age 48 years (range 19-62). Underlying disease were: AML 2, MM 7, NHL 9, HD 3, POEMS 1 and germ cell tumours 2. Chest radiograph was routinely performed in all pts. At insertion pts' disconfort was minimal. No early complication as haematoma and pneumothorax were observed. PICCs were in place for an inclusive period of 468 days (median time 19 days, range 6-32). Three out 24 of PICCs (12.5%) were removed due to bad positioning and for this reason inserted again. Six out of 24 pts (25%) presented a transient malfunction during stem cell infusion because PICCs resulted not adequate despite the low hematocrit of stem cell product infused. No pts developed clinically evident catheter-relater thrombosis (CRT). Accidental removal of the catheter occurred only in one pt. Infections were the most relevant late complication. Two out of 24 pts presented a catheter related bloodstream infection (CRBSI). In both cases cultures of blood and catheter samples documented a concordant growth of the same micro-organism, Staphylococcus Epidermidis. For this reason PICC was removed in one pts. The infection rate of 8% equates to 4.0 infections per 1000 PICCdays. Twenty of PICCs (83%) were removed due to completion of therapy, 1 PICC (4%) was removed for CRBSI, 1(4%) for fever of unknow origin (FUO) and 2 out 24 (8%) for other causes (accidental removal and malfunctioning). In our experience PICCs are associated with a rate of CRBSI similar to conventional central venous catheter but with a good pts' compliance and reduced risk for early complications.