Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter‐Days

Background Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7‐year, prospective cohort study was to compare the incidence rate differences of catheter‐related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). Methods We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. Results We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled‐cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter‐days. Overall, the rate of total CRCs was 1.08/1000 catheter‐days. The incidence of catheter‐related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled‐cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled‐cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter‐related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled‐cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled‐cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled‐cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. Conclusion PICCs had significantly better outcomes than tunneled‐cuffed CICCs and were safe and durable as ports. Our extensive, long‐term study suggests that PICCs can be successfully used as safe and long‐lasting VADs for HPN in cancer patients.