PICC Insertion and Management in ACUTE Myelogenous Leukemias: A 16-YEARS Monocentric Experience
Authors: Derudas Daniele , Chiriu Sabrina , Romani Claudio , Pilo Federica , Pettinau Martina , Longhitano Giuseppe , Ibba Daniela , Aracu Loredana , Atzori Monica , La Nasa Giorgio 
Published: December 2024

Background: Acute myelogenous leukemias (AMLs) are cancers of bone marrow cells that requires intensive chemotherapy and target-therapies, in combination with hematopoietic stem cells transplantation (HSCT) in fit patients and less intensive treatment in elderly patients. Supportive care is also advised due to disease and therapy-related cytopenia that can lead to life-threatening systemic infections, bleeding, and hypoxemia.

Introduction: The Peripherally Inserted Central Catheter (PICC) may be a safe and useful tool for the treatment of AMLs patients because it is easier to implant and has a lower rate of infectious complications than the Centrally Inserted Central Catheters (CICC).

Methods: Since its establishment in our medical oncology department, a PICC team consisting of a hematology physician and three dedicated nurses has conducted a prospective study to evaluate the efficacy and complication rate of the PICC device in inpatient and outpatient AML patients. Inclusion criteria included all AML patients who required chemotherapy, supportive care, and HSCT, regardless of white blood cell (WBC) count. A platelet count greater than 20000/mm3 and normal coagulation tests were required for implantation. In all patients, the vascular anatomy of the arms was previously examined by ultrasound. All implantations were performed under ultrasound guidance followed by radiographic control.

Results: From March 2007 to October 2023, 232 PICC implantations were performed in 201 patients (117 men and 84 women), including 13 patients with acute promyelocytic leukemia, after the conclusion of the induction phase. Median age 62 years (range 22-79). The majority of implantations were performed in hospitalized AML patients (208 - 90%). One hundred ninety-one PICCs (82%) were used for chemotherapy, thirty-one (14%) for supportive care, four (4%) for autologous HSCT, five (6%) for allogeneic HSCT. Only two PICCs were lost to follow-up in the AML population. Therefore, the analysis of duration and complications was performed on 230 devices (two patients lost at follow-up). At the time of this analysis, 6 of 230 PICCs (3%) are still in situ and in use. The total duration of PICC life was 26919 days (median, 98; range, 0-959). The reasons for removal in the two populations are shown in Table1. Of note, most PICCs were not removed for complications but because of end of therapy (44%) and exitus (33%), and only two in five (40%) had suspected catheter-related bloodstream infection confirmed by microbiological testing. Complications recorded in the global populations are described in the Table.2

No complications occurred in 67% of PICCs. There were 39 episodes of confirmed PICC-related septicemia recorded (17%; 1.5/1000 days/PICC). The pathogens isolated in blood cultures and PICC tip analysis were: Staphylococcus Epidermidis, Staphylococcus Hominis, Staphylococcus Warneri, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecium, Enterococcus Fecalis, Stenotrophomonas Maltophila, Bacillus Cereus, Klebsiella Pneumoniae, Candida spp. In only 12 of 39 confirmed PICC-related septicemias (31%) did the devices need to be removed, whereas in the other 23 cases (69%), PICC were left in place after the infection resolved with systemic antibiotic therapy. There were only 4 (2%; 0.14/1000 days/PICC) cases of symptomatic thrombotic complications related to PICC without the need for removal.

Conclusions. These data indicate that the use of PICC can be considered a safe and useful tool in the treatment of AML patients because it is easy to insert, safe to use, long lasting, and has a low complication rate, even in the case of PICC-related systemic infections.