Cotogni - PICC in NPD

(1)

S. Giovanni Battista

Il PICC, presidio di

prima scelta nel paziente

in Nutrizione Parenterale Domiciliare?

Università di Torino

Paolo Cotogni

SS Nutrizione Parenterale nel Paziente Oncologico

(2)

IV

(3)

ý  A central VAD is mandatory for

home parenteral nutrition (HPN)

Venous access device (VAD)

ý  Which type of medium- long term

(4)

(5)

ü  PICC can be recommended

for HPN patients?

Questions open to the discussion

ü  PICC can be recommended

(6)

Safety and Efficacy of Total Parenteral

Nutrition Delivered via a Peripherally

Inserted Central Venous Catheter

Alhimyary et al; Nutr Clin Practice, 1996

‘PICC lines can be used safely and effectively for TPN

and are associated with an acceptable rate of complications’

(7)

q  CVCs most appropriate for PN

therapy in the home setting include peripherally inserted central

catheters (PICC), tunneled

(8)

- January 1995 to December 2000 (questionnaire) - 447 patients; 110,869 catheter days

- Tunneled-external (90%); Implantable port (10%)

Clin Nutrition, 2002

CVCs for HPN

(9)

CVCs for HPN

PICC (?)

(10)

(11)

(12)

(13)

(14)

‘Neglected’ risk factors for CRCs:

q  exit site

q  ‘blind’ venipuncture

q  use of suture for securing the catheter

q  cuff <2 cm from exit site (tunneled

Groshong catheters)

(15)

Table 3. Infectious complications

a_{P < 0.01 vs. Hohn and Tunneled} b_{P < 0.01 vs. Hohn}

c_{P < 0.05 vs. Tunneled}

(16)

Table 4. Non-infectious complications

a_{P < 0.01 vs. Hohn} b_{P < 0.05 vs. Hohn} c_{P < 0.001 vs. Hohn}

(17)

PICC for up to …?

The use of most types of PICCs is approved

(18)

Since June 2008,

we started to propose a PICC

placement

in cancer patients proposed as

candidates for chemotherapy and/ or HPN,

independently from the expected duration of therapies

Study design

(19)

S. Giovanni Battista

Percentage of HPN patients with the different VADs per year

P. Cotogni, et al (submitted) 0 10 20 30 40 50 60 70 At May 31, 2008 2008-‐09 2009-‐10 2010-‐11 2011-‐12 2012-‐13 2013-‐14 VAD s (%)

(20)

q  Patients

We enrolled 669 cancer patients

q  VADs We studied 721 VADs:

•  

269 PICCs

•  

184 nontunneled catheters

•  

89 tunneled catheters

•  

179 ports

for a total of 141,052 catheter-days

Prospective, observational, cohort study from June 1, 2008 through May 31, 2013. Results

(21)

(22)

(23)

(24)

PICCs vs. tunneled-cuffed catheters

§

 

lower incidence of CRBSIs

§

 

lower incidence of overall complications

§

 

longer catheter life-span

Discussion

(25)

Major criticism

As long-term VAD, PICC is assessed in a

critical way because the exit site on the

arm effectively renders inoperative one

hand

As a consequence, PICC self management

presents many difficulties, so the patient

requires the assistance of a caregiver

According to our Regional policy, all the

cancer patients on HPN must have at least

(26)

(27)

Conclusion

Yes,

we PICC

ü  PICC can be recommended