Implementation of the Peripherally Inserted Central Venous Catheter for Patients with Hematological Malignancies in a Peruvian Cancer Center

Background: A central venous access is essential during active treatment for most patients with hematological malignancies, and historically, the central inserted venous catheter (CVC) has been the preferred option in clinical practice. In the last years, the peripheral inserted central catheter (PICC) has increasingly been used as an alternative to CVC with less incidence of catheter related infections (CRI). Our aim was to compare the incidence of documented catheter related infections and mortality for patients with PICC versus CVC.

Methods: We prospectively enrolled patients who were candidates for PICC implantation from March 2018 to February 2019, and matched them with a CVC candidate patient. PICC patients were followed at our PICC line program and CVC patients with their primary oncologist team as per institutional protocol. All patients received intensive treatment at a public tertiary cancer center in Lima-Peru (Instituto Nacional de Enfermedades Neoplasicas).

Results: We included 94 cases during the study period (44 PICC and 50 CVC cases), median age was 39 years and M:F ratio was 2:1. In the PICC group, main diagnoses were acute leukemias (46%), Lymphomas (22%) and Multiple Myeloma (16%), on the other hand, in the CVC group, acute leukemias (72%), lymphoma (16%) and multiple myeloma (8%). Mean length of catheterization was 40 and 24 days for PICC and CVC, respectively. The incidence of documented CRI was lower in PICC group (12.6 versus 3.1 per 1000 days for CVC and PICC, respectively), showing a risk reduction of 75% of bacteremia (RR: 0.25, 95%CI 0.1-0.6, p<0.01). Mortality rate was 20% and 14% in CVC and PICC groups, respectively (p=0.4).

Conclusion: PICC represents a safe and effective alternative to CVC for patients with hematological malignancies in a limited source setting. An alarming high incidence of catheter related infections was noted in this study.