COMPLICATION PROFILE OF PERIPHERALLY INSERTED CENTRAL CATHETERS IN ONCOLOGICAL SETTING, SINGLE CENTRE EXPERIENCE IN NORTH INDIA.
Abstract
In hemato-oncological setting, long term drug delivery route is very much needed. Peripherally inserted central catheters (PICC) are used for this purpose. There is no study reported from Jammu and Kashmir. This was a prospective observational study over a period of one year in the department of Medical Oncology at Khyber super speciality hospital Srinagar in north India. The data was collected with respect to gender, disease, catheter dwell time and complications.
AIM: To study the complications associated with PICC insertion and ease of administration.
Methods: All patients who needed chemotherapy or supportive care for more than 4 months as per standard chemotherapy protocols were included and where chemotherapy protocols were just bolus doses and shorter than four months were excluded. After all antiseptic precautions, PICC were inserted either USG guided or unguided depends upon visualization of upper arm veins. USG was used to guide cannula of PICC and rest procedure was totally blind. Position of PICC was confirmed with two techniques, and the length was adjusted at angle of Louis with the use of guide wire. Ten millilitre of normal saline flush was used and patient was asked to report any hissing sound or cold sensation from ipsilateral ear, which was 100% confirmatory on x-ray chest done later on whether PICC line tip lied in sub-clavian or jugular vein. PICC line was then fixed with stat lock. The complications associated with procedure and long term problems were noted down.
Results: Out of 200 patients enrolled males were 120, 90% were inserted unguided. Most common disease was carcinoma stomach (35%) and dominant arm was used in 15%. Unguided procedures were done in 2 minutes with average blood loss of 2ml. Around 5% reported pain within 24 hours and 2.5% reported fever beyond 24 hours. Average dwell time for single PICC was 5 months and 35% developed line fracture which was correctable. Only 3% developed serious complications viz; CABSI (Catheter associated blood stream infections) in 2.5% and thrombosis in 0.5%.
Keywords: PICC-peripherally inserted central catheter, USG—ultrasonography, CABSI- catheter associated blood stream infection, CVC- central venous catheter.
