SESSION TITLE: Hot Topics in Pediatic Pulmonology
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM
PURPOSE: Cystic fibrosis (CF) patients often require intravenous (IV) antibiotics via totally implantable venous access devices (TIVAD) or peripherally inserted central venous catheters (PICC) for treatment of respiratory tract infections. Complications of these lines in CF patients may be associated with significant morbidity but risk factors for complications have not been firmly established in multi-center studies.
METHODS: We conducted a retrospective review of PICCs and TIVADs in both adults and children over a five-year period at 3 accredited CF Centers. Recorded patient characteristics included genotype, co-morbid conditions, lung function, body mass, and respiratory tract microbiology. Line-specific information included catheter caliber, lumen number, site of insertion, and presence or absence of antimicrobial coating. Vascular complication was defined as venous thromboembolism or line occlusion. Infectious complications included blood stream infections or local cellulitis. Variations in practice were assessed by a survey of study site attending physicians.
RESULTS: A total of 724 PICC and 133 TIVADs were evaluated between June 2, 2006 and July 1, 2011. Demographics of the study group reflected the general US CF population. The overall complication rate per inserted catheter was 13%, which included 6 events/ 1,000 catheter days (1KCD) for PICCs and 0.2 events/1KCD in TIVADs. The infectious complication rate in PICCs and TIVADs was 2/1KCD and 0.08/1KCD, respectively. The vascular complication rate in PICCs and TIVADs was 2/1KCD and 0.02/1KCD, respectively. PICC complications occurred in patients with higher HgA1C, lower lung function, more frequent central venous access, larger caliber lines, and mucoid Pseudomonas or Burkholderia sp. In TIVADs, infectious complications were five times more common than vascular ones. Center effects were observed in complication rates.
CONCLUSIONS: Rates of vascular and infectious complications of PICCs and TIVADs have been determined in a large cohort of adult and pediatric patients at 3 CF care centers. Specific demographic and catheter-related characteristics associated with increased complication rates.
CLINICAL IMPLICATIONS: Data from this study should help inform guidelines for intermediate and long-term venous catheter care in CF patients.
DISCLOSURE: The following authors have nothing to disclose: Teresa May, Janet Trang, Karyl Gonzalez, Sasha Cornell, Alex Gifford, Worth Parker, Thomas Lahiri, Jonathan Zuckerman
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