WS09.1 Should we advocate a structured venous access policy in adults with CF?

• Published in: Journal of cystic fibrosis 2015-06, Vol.14, p.S17-S17
• Main Authors: Colpaert, K, Ruelens, C, Lorent, N, Van Bleyenbergh, P, Dupont, L.J
• Format: Article
• Language: English
• Subjects: Pulmonary/Respiratory
• ISSN: 1569-1993; 1873-5010
• DOI: 10.1016/S1569-1993(15)30052-7

Background Peripherally Inserted Central Catheter (PICC) & Totally Implanted Access Device (TIVAD) are widely used to provide venous access for CF patients. Increased concerns have been raised on the long-term risks. Method Increase in observed complications at our center has prompted us to survey problems with PICC & TIVAD from 2006 to 2013 in order to establish a structured venous access policy. Results Despite overall satisfaction with PICC we registered an adverse event rate of 20% (3% insertion complication, 6% insertion site problems, 2% thrombosis and 9% other PICC dysfunction) which resulted in removal of PICC in 1/3 of events. The number of TIVAD insertions declined slightly during this period. Retaining TIVAD after lung transplantation was associated with an increased risk of bloodstream infections (41% of pts with TIVAD, 75% asymptomatic) and 5 patients with TIVAD developed severe mitral valve insufficiency resulting in valve replacement surgery in 3 patients. Four incidents of problematic insertion of ECMO or hemodialysis catheters were registered in the 2 years. Discussion Based on these data and recent literature the following venous access policy was adopted. – screening for hypercoagulability – use of peripherally inserted catheters in both arms – insertion of PICC restricted to non-dominant arm – LMWheparin SC during PICC in pts with previous thrombosis or hypercoagulability – promoting TIVAD in pts with >3 IV / year – insertion TIVAD restricted to non-dominant arm – yearly Doppler-US in pts with PICC or TIVAD – immediate removal of TIVAD after transplantation