A comparison of Catheter-Related Infection in oncology patients with Peripherally Inserted Central Catheter versus Totally Implantable Centrall Acess Device

Abstract

A comparison of Catheter-Related Infection in oncology patients with Peripherally Inserted Central Catheter versus Totally Implantable Central Access Device. Author: Lisa Bjerling. Supervisor: Maria Werner, MD, PhD. Abstract Degree project, Programme in Medicine. A comparison of Catheter-Related Infection in oncology patients with Peripherally Inserted Central Catheter versus Totally Implantable Central Access Device. Lisa Bjerling, 2017, Department of Infectious Diseases and Infection Control, Södra Älvsborg Hospital, Borås, Sweden. University of Gothenburg, Gothenburg, Sweden. Supervisor: Maria Werner, MD, PhD. Introduction: Catheter-Related Infection (CRI) is an important factor for morbidity in patients with a Central Venous Access Device (CVAD). The CRI-incidence differ between CVADs. In oncological care, CVADs used are for example Totally Implantable Venous Access Device (TIVAD) and Peripherally Inserted Central Catheter (PICC). Aim: To find whether PICC or TIVAD gives the lowest incidence of CRI in patients with solid tumors. Method: Records from 556 patients with CVADs (328 PICC and 228 TIVAD) inserted between 2015-2016 at Södra Älvsborg Hospital (SÄS) in Sweden were reviewed. The comparison of the CRI-incidence was made in two groups: Confirmed CRI and Total CRI (Uncertain CRI-episodes included). Data was analyzed with Kaplan-Meier survival function and Cox regression. Result: 320 patients with 356 CVAD episodes (165 TIVAD and 191 PICC) were analyzed. 200 patients were excluded (mainly because of that the CVAD was not inserted at SÄS or age <18 years). In the Total TIVAD CRI-group, 46 CRIs was found (1.04 CRI/1000 catheter-days) and 26 CRIs was found (1.77 CRI/1000 catheter-days) in the Total PICC CRI-group. In the Confirmed TIVAD CRI-group, 24 CRIs was found (0.5 CRI/1000 catheter-days) and 2 CRIs (0.13 CRI/1000 catheter-days) in the PICC group. A significantly lower risk of CRI in patients with PICC was found in the Confirmed CRI-group (Hazard Ratio=0.093, 95% Confidence Interval=0.01-0.869, p=0.037) but not in the Total CRI-group (Hazard Ratio=1.029, 95% Confidence Interval=0.438-2.157, p=0.945). Conclusion: In patients with solid tumors there was no significant difference in CRI-incidence between PICC and TIVAD. Patients with PICC had a significantly lower CRI-incidence in the Confirmed CRI-group, indicating that PICC might be a safer alternative. The CRI-incidence in both groups were equivalent with earlier studies. Further prospective studies are needed.