6325 PICC line complication rates in adolescent Hodgkin’s lymphoma patients

Objectives Most paediatric oncology patients require intravenous access for investigations and administration of chemotherapy. Traditionally this has been through a Hickman line, but increasingly peripherally inserted central catheter (PICC) lines are being used for adolescent patients. The benefits of PICC lines include that no general anaesthetic is required for insertion/removal, there is reduced scarring to the chest and adolescents can wash and dress themselves independently. However, PICC lines may encounter complications, with previous studies reporting that the dominant complication is occlusion/mechanical failure, with factors such as the number of PICC line lumens increasing this risk.¹ Therefore, an audit was performed with the objective to quantify the scale of PICC-related complications on a paediatric oncology ward and evaluate relevant factors that may contribute to occlusion risk. Methods The audit was conducted at a paediatric oncology specialist hospital centre, with local approval, and included patients treated for Hodgkin's lymphoma between November 2019 – November 2022. 11 patients met the audit inclusion criteria and ranged from age 9–17 years. For each patient, a data collector recorded the PICC line size, the arm in which it was inserted, whether it was single lumen or double lumen, details of any complications and how these were managed. Results 9 out of 11 patients (82%) had at least one recorded complication, with 3 patients (27%) experiencing more than one complication. 3 patients required a replacement PICC line due to complications, meaning a total of 14 PICC lines were audited. All PICC lines were single lumen and either 3Fr (n=1) or 4Fr (n=13) in diameter. The most common complication was PICC line thrombosis (n=11), followed by PICC line associated deep vein thrombosis of the arm (n=2), and the least common was Candidial sepsis (n=1). It is thought that PICC lines with very smaller diameters may be more prone to thrombosis.² In light of the audit, a recommendation will be made to the vascular access team to use the largest PICC size possible and only downsize if necessary. This will prevent the inappropriate use of 3Fr PICC lines in adolescent patients. Conclusion A high proportion of adolescent Hodgkin's lymphoma patients experienced a complication of their PICC line, most commonly line thrombosis. Although a small sample size, it highlights the need to consider factors that could minimise such events. These include using the most appropriate PICC line size, right arm placement and learning from the experience of adult vascular access teams. References Smith SN, Moureau N, Vaughn VM, Boldenow T, Kaatz S, Grant PJ, Bernstein SJ, Flanders SA, Chopra V. Patterns and Predictors of Peripherally Inserted Central Catheter Occlusion: The 3P-O Study. Journal of vascular and interventional radiology. 2017;28(5):749–756.e2. Scott-Warren VL, Morley RB. Paediatric vascular access. BJA Education. 2015;15(4):199–206.