Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study

BMC Cancer · 8 authors, 8 centres

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This prospective observational study of 233 cancer patients undergoing chemotherapy found that nearly half experienced a PICC-related complication, with complications categorized into early, late, or persistent onset patterns. Despite the high complication rate, over half of affected patients successfully retained their catheter through conventional interventions.

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The primary aim was to describe the clinical characteristics and timing of PICC-related complications. Kaplan-Meier analysis identified three temporal groups: early onset (within the first month), late onset (after the second month), and persistent onset (throughout the catheter-dwelling period). Among patients with complications, 44.6% required unplanned catheter removal, primarily due to dislodgement, thrombosis, and skin injury, while 55.4% were managed with conventional interventions. Catheter dwelling time did not differ significantly between patients with complications who had successful interventions and those with no complications. Limitations include a potentially overestimated complication incidence due to the active cancer population and a small sample size limiting analysis of rare events like bloodstream infection. The findings support the use of time-specific prevention protocols and indicate PICCs remain a viable option for short-term chemotherapy.

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cohort

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oncology

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ORIGINAL PAPER

PMC10515037

Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study

BMC Cancer

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ABSTRACT

Abstract Purpose The incidence of peripherally inserted central catheter (PICC)-related complications is higher in cancer patients than in noncancer patients. However, the pattern of specific complication occurrence over time remains unclear. The purpose of this study was to investigate the clinical characteristics of PICC-related complications in cancer patients undergoing chemotherapy. Methods This prospective, observational study was conducted at a university-affiliated hospital in Western China. Cancer patients undergoing PICC insertion for anticancer treatment were recruited and followed up until the first week after catheter removal. Any complications, including occurrence time and outcomes, were recorded. The trajectory of specific PICC-related complications over time were identify based on the Kaplan‒Meier curve analysis. Results Of the 233 patients analyzed, nearly half (n = 112/233, 48.1%) developed 150 PICC-related complication events. The most common were symptomatic catheter-related thrombosis (CRT) (n = 37/233, 15.9%), medical adhesive-related skin injury (MARSI) (n = 27/233, 11.6%), and catheter dislodgement (n = 17/233, 7.3%), accounting for 54.0% (n = 81/150, 54.0%) of total complications events. According to Kaplan‒Meier curve analysis, symptomatic CRT, pain, phlebitis, and insertion site bleeding were classified as the “early onset” group mainly occurring within the first month post-insertion. Catheter fracture and catheter-related bloodstream infection were classified as the “late onset” group occurring after the second month post-insertion. MARSI, catheter dislodgement, occlusion, and insertion site infection were classified as the “persistent onset” group persistently occurring during the whole catheter-dwelling period. Among the 112 patients with PICC-related complications, 50 (44.6%) patients had their catheters removed due to complications, and 62 (55.4%) patients successfully retained their catheters until treatment completion through conventional interventions. The major reasons for unplanned catheter removal were catheter dislodgement (n = 12/233, 5.2%), symptomatic CRT (n = 10/233, 4.3%), and MARSI (n = 7/233, 3.0%), accounting for 58.0% (n = 29/50, 58.0%) of the total unplanned catheter removal cases. Catheter dwelling times between patients with complications under successful interventions (130.5 ± 32.1 days) and patients with no complications (138.2 ± 46.4 days) were not significantly different (t = 1.306, p = 0.194; log-rank test = 2.610, p = 0.106). Conclusions PICC-related complications were pretty common in cancer patients undergoing chemotherapy. The time distribution of PICC-related complications varied, and medical staff should develop time-specific protocols for prevention. Because more than half of the patients with PICC-related complications could be managed with conventional interventions, PICCs remain a priority for cancer patients undergoing short-term chemotherapy. The study was registered in 02/08/2019 at Chinese Clinical Trial Registry (registration number: ChiCTR1900024890). Supplementary Information The online version contains supplementary material available at 10.1186/s12885-023-11413-0. Keywords: Cancer patients, Chemotherapy, Peripherally inserted central catheter, Catheter-related complications

CITATION EXPORT

Ruixia Liu, Huiqiong Xu, Lihui Pu et al.. Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study. BMC Cancer. (2023). https://doi.org/10.1186/s12885-023-11413-0

AUTHORS

8 · 8 CENTRES

Ruixia Liu, Huiqiong Xu, Lihui Pu, Xiaofeng Xie, Hongxiu Chen, Zhoupeng Wu, Huirong Chen, Xiaoxia Zhang

1Department of Nursing, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province P.R. China
2Division of Abdominal Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province P.R. China
3Menzies Health Institute & School of Nursing and Midwifery, Griffith University, Brisbane Queensland, Australia
4Griffith University, Nathan Campus, Brisbane Queensland, PO Box 4111 Australia
5Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital / West China School of Nursing, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province P.R. China
6Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province P.R. China
7Department of Vascular Surgery, West China Hospital, Sichuan University, No.37 Guo Xue Street, PO Box 610041, Chengdu, Sichuan Province P.R. China
8Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, No.37 Guo Xue Street, PO Box 610041, West, Chengdu, Sichuan Province P.R. China