The use of peripherally inserted central catheter (PICC) in adult with acute leukemia

The purpose of this study is to evaluate peripherally inserted central catheter (PICC) as a sole venous access device for management of patients with newly diagnosed leukemia. Forty-four PICCs (4-French, single lumen) were placed in 41 newly diagnosed acute leukemia patients mostly complicated with active systemic infection and bleeding tendency. Sonography-guided venipuncture using a 14-gauge needle sheath was performed because of no grossly visible forearm peripheral veins. PICC insertion sites were basilic vein in 14, brachial vein in 12, cephalic vein in 13, antecubital vein in 4, and in right internal jugular vein in one patient after failed antecubital approach. Catheter tips were placed at right atrium and superior vena cava junction in all. The catheters were used for infusion of fluid, chemotherapeutic agents, blood products, and total parenteral nutrition. No hematoma was encountered. The PICCs were used for a total 3219 catheter-days, with a mean indwelling time of 73.2 days (range 1-247 days). Complications occurred in 18 catheters (18 of 44, 40.9%): puncture site infection in 4, phlebitis in 2, sepsis in 3, catheter clotting in 4, central venous thrombosis in 2, cannulated vein thrombosis in 1, catheter kinking and hub leakage in 1, and accidental removal by nursing personnel in 1. Induction chemotherapy was accomplished in 75% of PICCs (33 of 44), with an average of 1.9 courses (range 1-5 courses). PICC is safe and useful as an interim central venous access device for management of critically ill, newly diagnosed adult acute leukemia patients complicated with active infection and bleeding tendency.