Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters: a propensity score-matched cohort study

Abstract

Objectives: To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities.

Design: A propensity-score matched cohort study.

Setting: A 980-bed tertiary referral hospital in South West Sydney, Australia.

Participants: In-patients referred to the hospital central venous access service for the insertion of a central venous access device.

Primary and secondary outcome measures: The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT).

Results: The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference -0.63/1000 catheter days, 95% CI -2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI -6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI -0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference -0.11 per 1000 catheter days, 95% CI -0.26 to 0.04, p=1.00).

Conclusion: There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.

Keywords: infection control; intensive & critical care; internal medicine; vascular medicine.

Figure 1

tFICC exiting at the mid-thigh. tFICC, tunnelled femorally inserted central catheter.

Figure 2

FICC tunnelled and exiting on the abdomen. FICC, femorally inserted central catheter.

Figure 3

Cumulative probability of all-cause catheter failure between FICC and PICC groups in the first month of dwell using the Cox’s PH model adjusted for catheter diameter and number of lumens. FICC, femorally inserted central catheter; PICC, peripherally inserted central catheter.