Peripherally Inserted Central Catheters (PICCs) in the CF Popula

In This Article

Abstract and Introduction

Cystic fibrosis (CF) is a common fatal genetic disorder characterized by chronic pulmonary infections, some of which require intravenous (IV) antibiotics. Peripherally inserted central catheters (PICCs) have proven to be an effective means of IV delivery in a variety of populations. An evaluation of the effectiveness of the use of PICCs for patients at a CF center in New England was conducted over a 25-consecutive month period. During this time, 61 PICCs were placed in 32 patients with CF requiring IV antibiotics. The catheters were in place for a median of 15 days (range 1-155 days). The total number of catheter days in this series was 1,139. Although no serious complications were encountered, minor complications or technical problems occurred in 18 (29.5%) of the 61 catheters. Complications included external breaks in the catheters, shoulder pain, phlebitis, catheter occlusion, accidental dislodgement, local irritation at the insertion site, and yeast infection at the insertion site. No long-term sequelae resulted, and the rate of IV antibiotic completion with this mode of IV access was high. As a result of the evaluation, PICC access remains the standard of care at this institution for patients with CF requiring IV antibiotics for pulmonary exacerbations.

Cystic fibrosis (CF) is the most common fatal genetic disorder among Whites, affecting over 20,000 people in the United States alone (Cystic Fibrosis Foundation [CFF], 2001; Wagner, 1997). CF is a multisystem disorder that affects exocrine function, primarily targeting the respiratory tract and gastrointestinal system. The gene that codes for the protein product, cystic fibrosis transmembrane conductance regulator (CFTR), was discovered in 1989 (Wagner & Sherman, 1997). This defective gene causes altered sodium and chloride transport leading to thick airway secretions, chronic respiratory infections, inflammation, and eventually respiratory failure.

Although currently no cure exists for C F, supportive therapy with the use of antibiotics for prophylaxis or for the treatment of pulmonary exacerbations has been helpful in maintaining lung function and extending life expectancy. In 2000, the mean forced exhaled volume in 1-second (FEV1) in CF patients was 73.5% of predicted, and the median survival age was 32.2 years. Both rates were up from those in 1990 (67.5% and 29.2 years respectively) (CFF, 2001). These numbers are encouraging and support the continued use of antibiotics in this population.

Numerous methods of IV delivery of antibiotics have been used for patients with CF including butterfly, peripheral lines, non-tunneled central catheters, and tunneled central catheters. Peripherally inserted central catheters (PICCs) have been proven very effective as a means of IV delivery in a variety of populations. The purpose of this investigation was to evaluate the effectiveness of using PICCs for the delivery of antibiotics for children and adults with cystic fibrosis in our institution.

Cite this: Peripherally Inserted Central Catheters (PICCs) in the CF Population: One Center's Experience - Medscape - Sep 01, 2003.

Table 1. Summary of Minor Complications
Age	c/m*	Reason for Catheter Removal	Duration (days)	Complication	Notes
30	c	End of therapy	18	Occlusion	Occlusion cleared with urokinase
16	c	Complication	1	Accidental dislodgement
15	c	End of therapy	14	Catheter break	Not repaired
15	c	Complication	1	Accidental dislodgement
18	m	End of therapy	23	Pain in shoulder
38	c	Complication	8	Accidental dislodgement Occlusion	Occlusion cleared with urokinase
16	c	Complication	2	Phlebitis
19	c	Complication	7	Phlebitis
21	c	Complication	31	Irritation at insertion site
21	c	End of therapy	155	Break in PICC	Repaired and functional
28	m	Patient preference	6	Break in PICC Pain in shoulder	Preferred placement of new line, no repair attempt
28	m	End of therapy	13	Pain in shoulder	Pain in shoulder, pulled back
13	m	Complication	18	Irritation at insertion site	Pain and erythema at site, switched to PO abx
13	c	Complication	19	Site infection: yeast	Treated with local ointment
15	m	Complication	4	Phlebitis	Red, inflamed, pain at infusion site
14	c	End of therapy	31	Occlusion	Occlusion cleared with urokinase

Note: * c = central placement of PICC; m = midline placement of PICC

Table 2. Summary of PICC Complications Based on Age Group
Complication	Number of Complications (< 18 years of age)	Number of Complications (> 18 years of age)	Rate of occurrence (%)
Break in PICC	1	2	4.9
Pain in shoulder	1	2	4.9
Occlusion	1	2	4.9
Accidental dislodgement	2	1	4.9
Irritation at insertion site	1	1	3.3
Phlebitis	3	0	4.9
Site infection	1	0	1.6

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