Management Experience of Peripherally Inserted Central Catheters in Pediatric Oncology Patients: A 15 Year Population-Based Study from Maritimes, Canada

OBJECTIVE:

Pediatric oncology patients may require a peripherally inserted central catheter (PICC) for their therapy. Data from adult oncology studies indicate a high risk of complications associated with PICC lines. However, little data exists on the management experience of PICCs in pediatric oncology population. The aim of the present study was to document and analyze the management experience and complications with use of PICC lines in pediatric cancer patients at our center.

METHODS:

All pediatric cancer patients in the three Maritime Provinces of Nova Scotia, New Brunswick and Prince Edward Island are managed at the IWK health center in Halifax, Nova Scotia in a shared care model with regional hospitals. After ethics approval, all pediatric cancer patients managed at the IWK health center from January 1^st 2000 through Dec 31^st 2014 who received a PICC line were identified for inclusion in the study. The following databases were used to integrate data on the study patients: (i) pediatric oncology hospital database, (ii) Provincial Cancer in Young People database, (iii) Electronic medical records, (iv) Pharmacy database (v) IWK central line database and (v) Hospital Health records. Patients who received PICC line for an indication not related to their oncologic diagnosis or management were excluded from analysis. SPSS version 22 was used for statistical analysis.

RESULTS:

A total of 125 PICCs were placed in 102 (11.8%) of the 864 oncology patients. Of these 86 patients received 103 PICCs for oncology related indications. Fifteen (17%) patients required >1 PICC line.

For the study cohort, gender ratio was 1:1. The median age at cancer diagnosis was 9.8 years (range: 0-19.3 years). Among the 86 patients who received PICC line, 37% had leukemia, 19% had lymphoma, 13% had brain tumor, 4% had sarcoma, and 28% had other diagnoses.

For the first PICC, catheter duration ranged from 0 to 175 days (median 18 days) for a total of 2370 catheter days. The site of insertion was through the antecubital (16%), basilic (31%), brachial (2%), cephalic (41%), jugular (8%), saphenous (2%) veins, and was unknown in 2 patients. In 44% of patients the insertion was through the right side, 56% the left side and was unknown in 2 patients.

The indication of the first PICC line included: (i) administration of chemotherapy or bone marrow transplant: 34 (39.5%), (ii) failure of a previous central venous catheter: 15 (17.4%) and (iii) supportive care such as antibiotics, parenteral nutrition or intravenous access: 37 (43.0%). The reasons for removal were as follows: (i) Complications: 24 (28.2%), (ii) elective removal: 55 (64.7%) and (iii) other reasons: 6 (7.1%). Among the 55 PICCs removed electively, 12 (14.0%) were removed at the completion of cancer treatment, 23 (26.7%) at the completion of supportive care, and 20 (23.3%) were replaced with another type of central venous catheter. Among the 24 PICCs removed due to complications, 6 were removed due to infection, 15 due to mechanical complications and 3 due to thrombosis.

CONCLUSION:

We found that PICC lines are frequently used in pediatric cancer patients for a variety of indications. Seventeen percent of the patients needed >1 PICC line. Further, close to 1/3^rd of the patients experienced a complication related to their PICC line. Our experience highlights the need to conduct further studies addressing (i) indications of PICC line insertion in pediatric oncology (ii) determination of causes of PICC line related complications to help guide PICC line indications. Identifying patients at high risk of PICC line related complications will aid judicious choice of PICC line in pediatric cancer patients.