Prospective unicentric analysis on the systematic use of peripherically inserted central catheters (picc lines) in allogenic hematopoietic stem cell transplantation

Background: In patients undergoing chemotherapy peripherally inserted central catheters (PICCs) seem to be associated with a lower rate of complications compared to conventional percutaneously inserted devices (CVADs). Moreover, the insertion and removal of PICCs are easier and the costs lower compared to CVADs. So far, there is limited experience on the use of PICCs in the setting of allogeneic hematopoietic stem cell transplantation (HSCT). In view of the advantages of PICCs vs CVADs, we decided to use PICCs in patients candidates to receive a HSCT. Here, we report the experience on the systematic use of PICCs in HSCT patients at the 'Sapienza' University of Rome. Methods: A total of 100 silicone or polyurethane PICCs have been inserted between October 2012 and August 2017. Catheter-related bloodstream infections (CRBSI), mechanical (malfunction, obstruction, dislocation, rupture) and catheter-related thrombotic complications (CRTCs) have been prospectively analyzed. Results: One hundred PICCs were insert into 100 patients (male/female 62%/38%; median age 47.5 years, range 18.7-64.8). Fifty-one patients received a HSCT from an unrelated donor, 33 from a sibling donor and 16 were haploidentical transplants. Fifty-six patients had an acute leukemia and 44 a chronic lymphoproliferative disease. Myeloablative (MAC) and reduced (RIC) intensity condition regimens were employed in 62 and 38 patients, respectively. Polyurethane and silicone PICCs were used in 52 and 48 patients, respectively. The devices were single lumen in 52 patients and double lumen in 48. Eighty-five and 15 PICCS were placed in the basilica and brachial vein, respectively. All devices were inserted without complications. CRBSIs occurred in 32% of cases, with a rate of 2.5 CRBIs per 1000 PICC days. A coagulase-negative Staphylococcus was the most common agent, not associated with clinically significant complications. The PICC was removed in all cases. In univariate analysis, PICC material was the only factor affecting CRBSIs: polyurethane 42% vs 20% silicone; p = 0.02. CRTCs were observed in 17% cases, with a rate of 1.3 CRTS per 1000 PICC days. Patients received anti- coagulant therapy with low-weight heparin followed by resolution. In univariate analysis, no variable showed a correlation with CRTC. Mechanical complications occurred in 15% of cases, corresponding to 1.2 mechanical complications per 1000 PICC days. The type of conditioning (MAC 33% vs RIC 56%; p = 0.014) and place of insertion (basilic 12% vs brachial vein 33%; p = 0.03) influenced mechanical complications. Both variables remained significant in multivariate analysis. Globally, the median duration of in situ PICC placement was 117 days (range16-561). Conclusions: In our experience, no complications have been observed with the use of PICCs in patients undergoing a HSCTs. Adverse events related to PICCs were manageable and did not affect transplant outcome. Silicone PICCs and a basilic vein access seem to correlate with a lower incidence of infectious and mechanical complications. We conclude that PICCs are a safe and reliable long-term venous access for patients undergoing an allogenic HSCT. Conflict of interest: All authors declare no conflict of interest