Peripherally Inserted Central Venous Catheters (PICCs) in Cystic Fibrosis

Multicenter study affirms safety and utility

Innovations in Pulmonology  & Sleep Medicine | Summer 2023

Chest infections in people with cystic fibrosis (CF) are treated with intravenous antibiotics, sometimes for several weeks. Peripherally inserted central venous catheters, or PICCs, provide a convenient way to administer IV antibiotics; however, they do have limitations, including risk of venous thrombosis, bloodstream infections and catheter occlusion, explains Alex Gifford, MD, Director, Adult Cystic Fibrosis Program, University Hospitals Cleveland Medical Center.

Alex Gifford, MD

“Peripheral veins are small, fragile and sensitive to certain medications, so IVs placed in these veins typically don’t last more than a few days,” Dr. Gifford explains. “PICCs are larger and longer IV lines inserted into veins of the upper arms by inpatient vascular access teams specially trained to use ultrasound. Ultrasound guidance at the bedside improves safety by reducing the potential number of needle sticks and usually eliminates the need to send patients to radiology for the same procedure. PICCs, or PICC lines, are convenient, safe tools to infuse multiple antibiotics for extended periods of time. They are simply removed when treatment is complete.”

Clinical evaluation of PICCs

Dr. Gifford co-led a recently completed study to determine best practices for PICC placement to optimize patient care and minimize complications. The results were published online ahead of print in the April 2023 issue of Chest.

“With so many of these lines being placed at CF care centers across the country and variation in how centers place and manage them, we wanted to ensure that current practices are generally safe,”  he says.

This prospective, observational study, funded by the Cystic Fibrosis Foundation, included 10 CF centers across the U.S. It’s the largest, most detailed assessment of PICC lines in CF patients, says Dr. Gifford. It enrolled both adults and children with CF from 2018 to 2021. The objectives of the study were to assess three categories of potential complications: the catheters themselves, how the catheters were placed and managed, and patient-level risk factors for specific complications. Complications of PICCs fall into two broad categories: bloodstream infections and thrombotic or local skin complications.

Study Outcomes

The study identified no catheter-related blood stream infections, which was striking, says Dr. Gifford.

“In retrospect, we question whether we saw no bloodstream infections because people with CF receive broad-spectrum antibiotics for their lung infections,” he says.

PICCs appear to be safer devices in this population, a likely consequence of improved management procedures, such as how the catheters are cleaned and dressed. “We see from chart-review studies that because PICCs are placed with ultrasound guidance, we know where a blood vessel is and how deep it is. This helps guide placement with fewer needle sticks and less tissue damage,” says Dr. Gifford. “The shift to using ultrasound to place catheters contributes to lower risk of complications.”

Dr. Gifford also emphasizes the importance of enrolling children with CF in the study. “This filled a knowledge gap in the literature,” he says. “We had no prospective, observational data on the use of PICCs in kids with CF. That was definitely an innovative part of this trial.”

“We observed considerable practice variation among the 10 CF care centers in how catheters are managed, yet we still saw a low rate of thrombosis and site complications, and there were no catheter-related blood stream infections. Most of the changes pertain to how these lines were placed and used, which evolved before our study. Essentially, we studied a new standard of care that will persist for a while.”

For more information about the study or using PICC lines in CF patients, call Dr. Gifford at 216-286-7415.

Contributing Expert:
Alex Gifford, MD
Director
Adult Cystic Fibrosis Program
University Hospitals Cleveland Medical Center
Associate Professor
Case Western Reserve University School of Medicine