Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience

  • Park, Kwonoh (Department of Internal Medicine, KEPCO Medical Center) ;
  • Lim, Hyoung Gun (Department of Radiology, KEPCO Medical Center) ;
  • Hong, Ji Yeon (Department of Internal Medicine, KEPCO Medical Center) ;
  • Song, Hunho (Department of Internal Medicine, Kandong Sacred Heart Hospital, University of Hallym College of Medicine)
  • Received : 2014.05.09
  • Accepted : 2014.07.19
  • Published : 2014.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminally ill cancer patients. Methods: A retrospective review was conducted on patients who underwent PICC at the hospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013 and December 2013. All PICCs were inserted by an interventional radiologist. Results: A total of 30 terminally ill cancer patients received the PICC procedure during the study period. Including one patient who had had two PICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. The median catheter life span was 14.0 days (range, 1~90 days). In 25 cases, catheters were maintained until the intended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%; 10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removal cases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related blood stream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication cases totaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 days and the median was seven days. There was no PICC complication-related death. Conclusion: Considering characteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage, and a limited period of survival, PICC could be a safe intravenous procedure.

목적: 이 연구는 임종기 암환자들에서 말초삽입중심 정맥카테터(peripherally inserted central catheters, PICC)의 안정성 및 효과에 대해 확인하고자 한다. 방법: 2013년 한 해 동안 한전병원에 호스피스 완화의료를 목적으로 입원한 환자들 중, 말초삽입중심정맥카테터를 시행 받은 환자들을 대상으로 후향적으로 의무 기록 관찰하였다. 모든 말초삽입중심정맥카테터는 중재적 방사선의사에 의해 삽입되었다. 결과: 언급한 기간 동안 30명의 임종기 환자에서 말초 삽입중심정맥카테터가 시행되었고, 그들 중 1명의 환자에서 2회의 삽입이 이뤄져, 전체적으로 31회의 말초삽입중심정맥카테터 삽입 횟수와 571일의 거치기간(PICC days)이 분석되었다. 말초삽입중심정맥카테터 거치기간(PICC days)의 중앙값은 14.0일(범위, 1~90일)이었다. 25예는 계획된 시기(퇴원, 전원, 사망 등)까지 유지하였으나, 6예에서는 여러 이유로 계획된 시기보다 조기에 PICC를 제거하였다(PICC 조기 제거율, 19%; 10.5/1000 PICC days). 따라서, 카테터 유지 성공 비율(catheter maintenance success rate)은 81%였다. PICC 조기 제거 6예 중, 섬망 등에 의한 스스로 제거한 경우가 4예였고(13%; 7.0/1000 PICC days), 카테터 관련 혈액 감염 및 혈전증이 각각 1예씩 있었다(3%; 1.8/1000 PICC days). 조기 PICC 제거를 포함한 총 합병증 발생은 8예에서 있었다(26%; 14.1/1000 PICC days). 합병증 발생까지 기간은 중앙값 7일이었다(기간, 2~14일). 말초삽입중심정맥카테터 관련 합병증에 의한 사망은 없었다. 결론: 좋지 않은 전신 상태, 작은 시술 합병증에도 취약함, 제한된 여명등과 같은 임종기 암환자의 특징을 고려할 때, PICC는 임종기 환자에서 안전한 혈관 접근 방법이 될 수 있다.

Keywords

References

  1. Cleeland CS. Cancer-related symptoms. Semin Radiat Oncol 2000; 10:175-90. https://doi.org/10.1053/srao.2000.6590
  2. Bruera E, Sala R, Rico MA, Moyano J, Centeno C, Willey J, et al. Effects of parenteral hydration in terminally ill cancer patients: a preliminary study. J Clin Oncol 2005;23:2366-71. https://doi.org/10.1200/JCO.2005.04.069
  3. Mercadante S, Ferrera P, Girelli D, Casuccio A. Patients' and relatives' perceptions about intravenous and subcutaneous hydration. J Pain Symptom Manage 2005;30:354-8. https://doi.org/10.1016/j.jpainsymman.2005.04.004
  4. Lam S, Scannell R, Roessler D, Smith MA. Peripherally inserted central catheters in an acute-care hospital. Arch Intern Med 1994;154:1833-7. https://doi.org/10.1001/archinte.1994.00420160070009
  5. Ng PK, Ault MJ, Ellrodt AG, Maldonado L. Peripherally inserted central catheters in general medicine. Mayo Clin Proc 1997; 72:225-33. https://doi.org/10.4065/72.3.225
  6. Gunst M, Matsushima K, Vanek S, Gunst R, Shafi S, Frankel H. Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 2011;12:279-82. https://doi.org/10.1089/sur.2008.058
  7. Raad I, Davis S, Becker M, Hohn D, Houston D, Umphrey J, et al. Low infection rate and long durability of nontunneled silastic catheters. A safe and cost-effective alternative for long-term venous access. Arch Intern Med 1993;153:1791-6. https://doi.org/10.1001/archinte.1993.00410150073007
  8. Smith JR, Friedell ML, Cheatham ML, Martin SP, Cohen MJ, Horowitz JD. Peripherally inserted central catheters revisited. Am J Surg 1998;176:208-11. https://doi.org/10.1016/S0002-9610(98)00121-4
  9. Kim HJ, Yun J, Kim HJ, Kim KH, Kim SH, Lee SC, et al. Safety and effectiveness of central venous catheterization in patients with cancer: prospective observational study. J Korean Med Sci 2010;25:1748-53. https://doi.org/10.3346/jkms.2010.25.12.1748
  10. Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S. Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. J Pain Symptom Manage 2001;22: 997-1006. https://doi.org/10.1016/S0885-3924(01)00360-8
  11. Yamada R, Morita T, Yashiro E, Otani H, Amano K, Tei Y, et al. Patient-reported usefulness of peripherally inserted central venous catheters in terminally ill cancer patients. J Pain Symptom Manage 2010;40:60-6. https://doi.org/10.1016/j.jpainsymman.2009.11.327
  12. Kim EJ, Kim HJ, Kim HJ, Kim KH, Kim SH, Lee SC, et al. Retrospective analysis for complications of the central venous catheter in patients with cancer at a single center in Korea. Korean J Hosp Palliat Care 2010;13:24-31.
  13. Bruera E, Hui D, Dalal S, Torres-Vigil I, Trumble J, Roosth J, et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol 2013;31:111-8. https://doi.org/10.1200/JCO.2012.44.6518
  14. Dalal S, Bruera E. Dehydration in cancer patients: to treat or not to treat. J Support Oncol 2004;2:467-79, 83.
  15. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348:1123-33. https://doi.org/10.1056/NEJMra011883
  16. Cheong K, Perry D, Karapetis C, Koczwara B. High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours. Intern Med J 2004;34: 234-8. https://doi.org/10.1111/j.1444-0903.2004.00447.x
  17. Walshe LJ, Malak SF, Eagan J, Sepkowitz KA. Complication rates among cancer patients with peripherally inserted central catheters. J Clin Oncol 2002;20:3276-81. https://doi.org/10.1200/JCO.2002.11.135
  18. Yap YS, Karapetis C, Lerose S, Iyer S, Koczwara B. Reducing the risk of peripherally inserted central catheter line complications in the oncology setting. Eur J Cancer Care (Engl) 2006;15:342-7. https://doi.org/10.1111/j.1365-2354.2006.00664.x
  19. Young A, Chapman O, Connor C, Poole C, Rose P, Kakkar AK. Thrombosis and cancer. Nat Rev Clin Oncol 2012;9:437-49. https://doi.org/10.1038/nrclinonc.2012.106
  20. Young AM, Billingham LJ, Begum G, Kerr DJ, Hughes AI, Rea DW, et al. Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial. Lancet 2009;373:567-74. https://doi.org/10.1016/S0140-6736(09)60205-1
  21. Lavau-Denes S, Lacroix P, Maubon A, Preux PM, Genet D, Venat-Bouvet L, et al. Prophylaxis of catheter-related deep vein thrombosis in cancer patients with low-dose warfarin, low molecular weight heparin, or control: a randomized, controlled, phase III study. Cancer Chemother Pharmacol 2013;72:65-73. https://doi.org/10.1007/s00280-013-2169-y
  22. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000;160:809-15. https://doi.org/10.1001/archinte.160.6.809

Cited by

  1. Safety, efficacy, and patient-perceived satisfaction of peripherally inserted central catheters in terminally ill cancer patients: a prospective multicenter observational study vol.24, pp.12, 2016, https://doi.org/10.1007/s00520-016-3360-6
  2. Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study vol.53, pp.3, 2014, https://doi.org/10.4143/crt.2020.1008