PICC line or port catheter: Which one for cancer patients?

It can be challenging knowing when to insert a peripherally inserted central catheter (PICC) or port catheter into patients with cancer. The choice of central venous catheter (CVC) is critical in oncology. As an oncology professional, you have multiple factors to consider. Different options involve different benefits and potential complications.

What are the advantages of PICCs?

Oncological drugs and central venous access were developed after the end of World War II. The port catheter was invented around 1970. PICC lines have been available since the 1970s, but their use has increased significantly since 2000 for several reasons¹:

Ease of placement
Ultrasound guidance ensures proper position
Lower cost of insertion compared to other CVCs
Lower risk of bleeding
Ease of removal

What are the potential risks associated with CVCs?

What is the risk of BSIs between different CVCs?

Chopra et al performed a systematic review comparing complication rates between PICCs and other CVCs². According to the results, PICCs placed in inpatients were twice as likely to cause bloodstream infections (BSIs) than those placed in outpatients².

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2. What is the risk of thrombosis between port catheters and PICCs?

Thrombosis is more common in patients with cancer than those without cancer⁵. In systematic reviews conducted by Saber et al. and Yeow et al., it was found that thrombosis rates were higher in patients with PICCs than those with port catheters^6,7.

However, Chopra et al. suggested that the rates of thrombosis for PICCs may vary based on the techniques used to place them^5.Ultrasound navigation equipment can be used to ensure placement in the appropriate vessel³.

3. What are the rates of IV catheter-related complications for PICCs?

Prof. Baudolino Mussa from the University of Turin and colleagues carried out a prospective study on PICCs in outpatients with cancer3. They found that rates of IV catheter-related complications (CRBSIs, thrombosis and mechanical complications) were low with PICCs³.

The main finding of Mussa et al. was that when PICCs are maintained properly using evidence-based protocols, they have relatively low rates of complications; are less likely to be removed because of complications; and provide long catheter life spans³.

Can PICCs be a safe method for administering chemotherapy?

In a seven-year study of 2,477 patients, Campagna et al. found that PICCs can be safe for administering oncological drugs in the medium- to long-term with low rates of infection and thrombosis⁸.

Choose a CVC adapted to the specific needs of your patients

When can port catheters be used?

Mielke et al. recommend against using port catheters for less than 30 days⁴. They should not be placed for standard radiation protocols (less than 60 days) either⁴.

When can PICCs be used?

According to Mussa et al., PICCs may be used safely in oncology patients if they are inserted and managed correctly³. Their duration can be extended from a few weeks to up to 6 months⁴. Unlike port catheters which require minor surgery for placement, PICCs offer the advantage of a lower risk of procedure-related trauma⁴.

The bottom line: One CVC doesn’t fit all

The same CVC cannot be used in all patients. It is important to choose the appropriate CVC based on the patient’s needs⁹. Prof. Mussa thinks this strategy may be able to reduce costs, lessen pain for patients and improve treatment quality. For more information, watch his presentation on this topic.

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References

Falzone L, Salomone S, Libra M. Evolution of Cancer Pharmacological Treatments at the Turn of the Third Millennium. Front Pharmacol. 2018;9:1300. doi: 10.3389/fphar.2018.01300
Li G, Zhang Y, Ma H, Zheng J. Arm port vs chest port: a systematic review and meta-analysis. Cancer Manag Res. 2019 Jul 3;11:6099-6112. doi: 10.2147/CMAR.S205988
Cotogni P, Barbero C, Garrino C, et al. Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study. Support Care Cancer. 2014;23(2):403-409.
Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer. 2020;28(10):4753-4760. doi: 10.1007/s00520-019-05276-0
Chopra V, Anand S, Krein SL, Chenoweth C, Saint S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med. 2012;125(8):733-741.
Saber W, Moua T, Williams EC, et al. Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. J Thromb Haemost. 2011;9(2):312-319.
Yeow M, Soh S, Yap R, Tay D, Low YF, Goh SSN, Yeo CS, Lo ZJ. A systematic review and network meta-analysis of randomized controlled trials on choice of central venous access device for delivery of chemotherapy. J Vasc Surg Venous Lymphat Disord. 2022:S2213-333X(22)00171-8. doi: 10.1016/j.jvsv.2022.03.007
Campagna S, Gonella S, Berchialla P, et al. Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days. Oncologist. 2019;24(9):e953-e959.
Campagna S, Gonella S, Zerla PA, et al. The Risk of Adverse Events Related to Extended-Dwell Peripheral Intravenous Access. Infect Control Hosp Epidemiol. 2018;39(7):875-877.

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News and innovation

PICC line or port catheter: Which one for cancer patients?

PICC line or port catheter: Which one for cancer patients?

What are the advantages of PICCs?

What are the potential risks associated with CVCs?

What is the risk of BSIs between different CVCs?

2. What is the risk of thrombosis between port catheters and PICCs?

3. What are the rates of IV catheter-related complications for PICCs?

Choose a CVC adapted to the specific needs of your patients

When can port catheters be used?

When can PICCs be used?

The bottom line: One CVC doesn’t fit all

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References