Indwelling Central Venous Access Devices (CVADs) including peripherally-inserted central catheters (PICCs) and totally implanted venous access ports (TIVAPs), are almost ubiquitous in oncology and haematology patients who require prolonged cycles of intravenous chemo- and immunotherapy. These devices are associated with several complications, including deep venous thrombosis, catheter blockage and line-associated infections. The rates of PICC- and TIVAP- associated complications in the Northern Territory population have not been previously published.
To investigate PICC- and TIVAP-associated complications in the Northern Territory population in patients receiving chemotherapy for oncological and haematological malignancies.
We conducted a retrospective audit of all CVAD insertions indicated for chemotherapy delivery in oncology patients at the Royal Darwin Hospital in 2015. Patient demographics, CVAD insertion and removal, and associated complications were .
A total of 136 insertions were identified in 112 patients: 120 PICC placements and 16 TIVAP insertions. In the PICC group (96 patients), mean age was 58.3 years and 54% (52/96) female. 27 PICCs were inserted in the inpatient setting, 93 in the outpatient setting. The mean duration of PICC placement was 113.75 days. 43 PICCs (37%) were associated with complications: 5 PICC-associated thromboses (12%), 17 infections (40%), 15 blockages (35%) and 5 other complications (12%). The mean duration of PICC line duration was 126.1 days in the no-complication group, and 96.0 days in the complication . The TIVAP group was 75% (12/16) female, with an mean age of 57.1 years. There were 2 (17%) documented complications: one subclavian vein stenosis requiring TIVAP removal, and one blocked catheter that remained in-situ.
The results suggest fewer complications with TIVAP insertion than PICC. However, PICC insertion was almost ten-times as frequent as TIVAP. Infection and catheter blockage were the most common complications. Further analysis is required to elucidate possible risk factors in this setting.