• Alex H Gifford, Alexandra C Hinton, Shijing Jia, Samya Z Nasr, Joel D Mermis, Thomas Lahiri, Edith T Zemanick, Charlotte C Teneback, Patrick A Flume, Emily A DiMango, Hossein Sadeghi, Deepika Polineni, Rebecca H Dezube, Natalie E West, Elliott C Dasenbrook, F Lee Lucas, and Jonathan B Zuckerman.
• Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Pediatric Pulmonology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH.
• Chest. 2023 Sep 1; 164 (3): 614624614-624.

BackgroundPeripherally inserted central catheters (PICCs) are used commonly to administer antibiotics to people with cystic fibrosis (CF), but their use can be complicated by venous thrombosis and catheter occlusion.Research QuestionWhich participant-, catheter-, and catheter management-level attributes are associated with increased risk of complications of PICCs among people with CF?Study Design And MethodsThis was a prospective observational study of adults and children with CF who received PICCs at 10 CF care centers in the United States. The primary end point was defined as occlusion of the catheter resulting in unplanned removal, symptomatic venous thrombosis in the extremity containing the catheter, or both. Three categories of composite secondary outcomes were identified: difficult line placement, local soft tissue or skin reactions, and catheter malfunction. Data specific to the participant, catheter placement, and catheter management were collected in a centralized database. Risk factors for primary and secondary outcomes were analyzed by multivariate logistic regression.ResultsBetween June 2018 and July 2021, 157 adults and 103 children older than 6 years with CF had 375 PICCs placed. Patients underwent 4,828 catheter-days of observation. Of the 375 PICCs, 334 (89%) were ≤ 4.5 F, 342 (91%) were single lumen, and 366 (98%) were placed using ultrasound guidance. The primary outcome occurred in 15 PICCs for an event rate of 3.11 per 1,000 catheter-days. No cases of catheter-related bloodstream infection occurred. Other secondary outcomes developed in 147 of 375 catheters (39%). Despite evidence of practice variation, no risk factors for the primary outcome and few risk factors for secondary outcomes were identified.InterpretationThis study affirmed the safety of contemporary approaches to inserting and using PICCs in people with CF. Given the low rate of complications in this study, observations may reflect a widespread shift to selecting smaller-diameter PICCs and using ultrasound to guide their placement.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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