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Tunneled Catheters vs PICC Lines: Which is Safer for Home TPN?
Patients with inflammatory bowel disease (IBD) are at risk of malnutrition and often require home parenteral nutrition support. These patients are also at 3 times the risk for venous thromboembolism (VTE) as people without IBD, Mohamed Taysuf Siddiqui, MD, explained in reporting the results of a study he and colleagues at Cleveland Clinic conducted on the risks of deep vein thrombosis (DVT) among patients receiving home parenteral nutrition.
This presentation received the Fellows-in-Training Award in the Small Intestine Category.
The study was designed to assess the catheter-associated DVT (CA-DVT) burden on patients with IBD receiving long-term parenteral nutrition at home, and to compare the rates of DVT between the 2 most commonly used catheters, tunneled catheters and peripherally inserted central catheters (PICC).
Through a retrospective chart review, the researchers identified 407 patients with IBD who received parenteral nutrition at home from January 1, 2013, through June 30, 2019; a total 744 catheter episodes (defined as the placement of a catheter for parenteral nutrition); and 33 patients who experienced CA-DVT as diagnosed by ultrasound, for a CA-DVT rate of 4.4%.
Of the 744 catheters placed, 72.4% were tunneled catheters and 27.6% were PICC lines. There were 22 incidents of CA-DVT in the tunneled catheter group and 11 in the PICC group, for DVT rates of 4.1% and 5.4%, respectively. A weighted analysis adjusted for the duration of catheter episodes revealed that the rate of DVT per 1000 catheter days was 0.16 for the PICC group and 0.08 for the tunneled catheter group.
“Patients with IBD receiving nutritional support via PICC are at significantly higher risk of DVT than patients using tunneled catheters for home parenteral nutrition,” Dr Siddiqui said. “We recommend tunneled catheters in patients with IBD who will require nutritional support for more than 4 to 6 weeks.”
—Rebecca Mashaw
Reference:
Siddiqui MT, Koenen B, Al Yaman W, et al. Tunneled intravenous catheters for home parenteral nutrition have a lower rate of deep vein thrombosis than PICC lines in inflammatory bowel disease. Talk presented at: American College of Gastroenterology Clinical Meeting and Postgraduate Course. October 27, 2020. Virtual.
