Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment
Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment
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DOI：
10.1007/s00520-019-05276-0
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发表时间：
2020-01-22
影响因子：
3.1
通讯作者：
Teichgraeber, Ulf
中科院分区：
文献类型：
--
作者：
Mielke, Dorothea;Wittig, Andrea;Teichgraeber, Ulf
目的：经外周静脉置入中心静脉导管（PICC）用于肿瘤放疗患者在门诊和住院治疗期间的通路，目前尚无证据。方法2011年11月至2016年7月在放射肿瘤科共对484例患者进行了522次PICC放置，并回顾性分析了门诊和住院使用期间的并发症以及治疗和患者相关因素。在首次住院时，所有患者均接受了多模式放射肿瘤治疗，包括放射治疗和通过PICC进行的静脉治疗。结果共记录了18，292个导管日。从导管插入到取出的中位随访时间为37天（1-97）。总体并发症发生率为4.1/1000导管日（n = 75，14.4%）。门诊患者队列和住院患者队列的并发症相似，分别为3.6/1000导管日和4.8/1000导管日（OR 0.976; 95% CI [0.598; 1.619]; p = 0.924）。严重血流感染的发生率为0.60/1000导管日（n = 11，2.1%），深静脉血栓形成的发生率为0.82/1000导管日（n = 15，2.9%），局部炎症的发生率为1.26/1000导管日（n = 23，4.4%）。只有免疫治疗可以被确定为并发症的独立风险因素（OR 5.6; 95% CI [2.4; 13.1]; p < 0.001）。结论在门诊患者中使用PICC与并发症的风险无关。应特别注意PICC相关血流感染的早期识别。免疫治疗是局部皮肤并发症的独立危险因素。
Purpose So far there is little evidence on peripherally inserted central venous catheter (PICC) in radiation oncology patients maintaining the access during the periods of ambulatory and hospital treatment. Methods A total of 522 PICC placements in 484 patients were performed between 11/2011 and 07/2016 at the Department of Radiation Oncology and analysed retrospectively for complications and treatment- and patient-related factors during ambulatory and hospital inpatient use. On initial hospitalization, all patients received a multimodal radio-oncological treatment consisting of radiation and intravenous therapy administered via the PICC. Results A total of 18,292 catheter days were documented. Median follow-up from catheter insertion to their removal was 37 days (1-97). The overall complication rate was 4.1 per 1000 catheter days (n = 75, 14.4%). Complications were similar between the cohort of outpatient 3.6 per 1000 catheter days and the cohort of inpatient 4.8 per 1000 catheter days (OR 0.976; 95% CI [0.598; 1.619]; p = 0.924). Severe bloodstream infections occurred at a rate of 0.60 per 1000 catheter days (n = 11, 2.1%), deep vein thrombosis at a rate of 0.82 per 1.000 catheter days (n = 15, 2.9%) and local inflammation at a rate of 1.26 per 1.000 catheter days (n = 23, 4.4%). Only immunotherapy could be identified as an independent risk factor for complications (OR 5.6; 95% CI [2.4; 13.1]; p < 0.001). Conclusion Using PICC in outpatients is not associated with an elevated risk of complications. Particular attention should be payed to early identification of PICC associated bloodstream infections. Immunotherapy is an independent risk factor for local skin complication.