Peripherally inserted central venous catheter(PICCs) are widely used nowadays in providing intermediate and long term venousaccess in hospital, namely for long term administration of antibiotics,parenteral nutrition and chemotherapy. Being a less invasive alternative ofcentral venous access give rise to its popularity over conventional centralvenous catheters (CVCs) They are however, not without associatedrisks and complications. Among the common risks and complications related toPICCs are phlebitis, thrombosis, premature dislodgement, malfunction andcentral line-associated blood stream infection (CLABSI).
A study by Carlson in 2003 showed up toone-third of PICCs removed as a result of a complication. A more recent studyby Delphine Grau et at in 2017 showed similar rate of 30.2% out of 163 catheters with a mean time to onset of16.1 days.
While Carlson reported the most common reason wasinfection, Delphine Grau revealed occlusion being the most commoncomplications. Both reported similar rate of infection as 7.4% and 6.3%respectively. Other complicationsreported by Delphine Grau also include accidental withdrawal (8.
9%), venousthrombosis (1.6%) and hematoma (1%) (1). The implication of theserisks is increase cost for patient management results from prolonged lengths ofhealth care stay. The reported increased costs ranges from $3,700 to $29,000per episode (2-4)and a total yearly cost of $300 million to $2 billion for all U.
S health carefacilities (5). Most of the studies only compared CLABSI ratebetween conventional CVC and tunneled CVC, CVC and conventional PICC or betweendifferent types of conventional PICCs (6). While we have learnt from studiesdone by Norazak et al at University Malaya Medical Centre (UMMC) in 2013 thattunneled PICCs have a lower rate of blood stream infection (BSI) compared toconventional PICCs (7), we continue to strive forcatheter factors and technique of catheter insertion which could potentiallyminimize the rate of BSI. Among the new PICCs are cuffed (medicated or non medicated impregnation – discussed later) PICCs which aredesigned with the aim to minimize the risk of both local and bloodstreaminfection. With this study we hope to determine if cuff can reduce infectionrate in PICC by comparing blood stream infection rate between tunneled cuffedPICC and tunneled non cuffed PICC.
We also hope to compare thecatheter-days and time to infection between these two methods, and also to lookat other catheter related complications such as local infection, catheterblockage and dislodgement.