580 - Venous Access in Immunocompromised Cancer Patients: A Single-Center Study Comparing Peripherally Inserted Central Catheters (PICC) To Tunneled Central Venous Catheters (TCVC) and Implanted Ports (IP)

Poster Number: 580
Publication Number: 580.321

Tatyana Lemelman, Eastern Virginia Medical School, Norfolk, VA, United States; Duane S. Duke, Eastern Virginia Medical School, Norfolk, VA, United States; Haree Pallera, Eastern Virginia Medical School, Virginia Beach, VA, United States

Background: A recent large multi-center study found that there are significantly more thrombotic complications, infections, and line malfunctions in PICC lines compared with TCVCs. Surgical/placement complications were not addressed. Oncological patients are at increased risk for bleeding and infectious complications while undergoing surgical procedures at the time of diagnosis due to their critical illness. It is important to understand whether the identified complications are a greater risk than undergoing a surgical procedure in critically ill oncologic patients. In addition we will look to see if our institution has complication rates comparable to what has already been identified.

Objective: To compare incidence of thrombotic events, line infections, surgical complications, and catheter malfunctions between PICCs, TCVCs and Implanted Ports in patients with an underlying oncologic diagnosis.

Design/Methods: This study was approved by the institutional review board (IRB) prior to the start of any data collection (IRB #20-12-XX-0230). Patients who were diagnosed with a malignancy and had a PICC, TCVC, or IP placed between January 2017 and July 2020 underwent a retrospective chart review. Thrombotic events, bacteremia, and surgical complications/catheter malfunctions were recorded as distinct events and analyzed using chi-square and fisher’s exact tests. Complication rates were compared to look for any association with patient demographics, malignancy type, form of access, and neutropenic status.

Results: A total of 177 central venous lines (PICC/TCVCs/IPs) were identified in this study; only 38 (23.7%) of which were PICCs. Although PICCs were more likely to be placed in patients with severe or functional neutropenia (absolute neutrophil count < 500 or induction/prophase of leukemia/lymphoma chemotherapy), neither type of access nor neutropenic status were associated with increased incidence of complications. Additionally, only 5 of 21 cases of all bacteremia led to removal of the patient’s line due to concern for line infection. Study was not powered to assess if there was an increased risk of line removal among PICCs or TCVC/IPs. Among patients with TCVC/IPs, only female gender was associated with increased risk of developing a surgical complication (OR 6.8, p=0.014).Conclusion(s): Peripherally inserted central catheters and surgically placed tunneled central venous catheters/implanted ports are equally safe in oncology patients; there is no increased risk of developing thrombotic complications, bacteremia, surgical complications, or catheter malfunctions.