PICC Insertion and Management in Hodgkin Lymphoma Patients: A 10-YEARS Monocentric Prospective Study

Background: Hodgkin Lymphoma (HL) is a neoplastic hematologic disease that requires treatment with standard chemo-radiotherapy and, in relapsed patients, intensification with hematopoietic s cell transplantation (HCT).

Introduction: Insertion of a Peripheral Insertion Central Venous Catheter (PICC) instead of a Peripheral Venous Catheter (PVC) could simplify HL patients management and allow a safer therapy, according to their outpatient care.

Methods: Since the 2007, a PICC team, consisting of an hematology physician and two dedicated nurses has carried out a prospective study to evaluate complication rate and usefulness of PICC device in the hematology clinical practice, particularly in HL patients. Inclusion criteria included all HL inpatient and outpatient who needed program of chemo-radiotherapy, support treatment and HSCT, regardless of white blood cells (WBC) and platelets (PLT) counts. All patients underwent a previous evaluation of arms vascular anatomy by ultrasonography. All implantation procedures were performed under ultrasound guide with radiographic control following insertion.

Results: From March 2007 to January 2018, 228 attempts of PICC implantation were performed in 202 HD patients (104 male and 90 females). Median age was 35 years, range 16-85. Catheter insertion was successful in 220 cases (96.5 %) in 194 patients, whilst in 8 cases (3.5%) PICC insertion was not possible; 96 PICC were inserted in patients treated with a previous chemotherapy.

Two hundred and seven PICC (94%) were used for chemo-radiotherapy courses, five (2.3%) for support treatment, 7 (3.2%) for autologous HSCT, 1 (0.5%) for allogenic HSCT.

At the time of this analysis 7 out of 220 PICC (3.5%) are still in situ and in use, 180 (81.5%) were removed for end of therapy and 10 (4.5%) for accidental withdrawals. Only 23 PICC (10.5%) were removed because of catheter related complications: 2 (0.9%) for catheter rupture, 4 (1.8 %) for malfunctioning, 7 (3.2%) for occlusions, 4 (1.8%) for local infection, 6 (2.7%) for suspected PICC-related sepsis.

Only 3 episode of confirmed PICC-related septicemia (1.4 %; 0.1/1000 days/PICC) were recorded and Staphylococcus was isolated. There were only 5 episodes (2.3% ; 0.14/1000 days/PICC) of symptomatic PICC-related thrombotic complications, without need of removal. Two cases (0.9%) of delayed abnormal dislocation were recorded, fixed with subsequent replacement with guide.

PICC median life was 157 days (range 1-396) for a total of 34,764 days. The 365-day cumulative incidence of catheter removal for end of therapy (PICC life) was 95,5%±1.7%. No significant difference was found in patients underwent previous chemotherapy course (95.1±2.6 vs 95.8±2.1%, p=NS). Neither stage of disease WBC or PLT count had influenced on PICC life.

Conclusions. These data encourage the use of PICC as standard of care in the management of HD patients because of easy insertion, safety of use, duration of life and low rate of complication.