Abstract:
Background: Tunneled or implanted central venous catheters (CVCs) are recommended for long-term home parenteral nutrition (HPN), but some bedridden patients refuse to undergo surgical insertion. Although recent studies have demonstrated that peripherally inserted central catheters (PICCs) can be safely maintained for long-term HPN, they may also be impractical owing to patient or provider limitations. Non-tunneled, non-implanted centrally inserted CVCs (CICCs) offer bedside insertion; however, evidence on their long-term safety in home care remains limited.
Methods: We conducted a retrospective cohort study at a single home-visit center in Kyoto, Japan, enrolling patients who received HPN via CICC or PICC between January 2013 and June 2024. Patients with cancer expected to have short-term survival were excluded. The primary outcomes were central line-associated bloodstream infection (CLABSI) and catheter-related thrombosis (CRT). We calculated incidence rates per 1,000 catheter-days, estimated hazard ratios using Cox proportional hazards analysis, and compared CLABSI-free survival using Kaplan-Meier curves.
Results: A total of 16 patients (CICC: n=12; PICC: n=4) contributed 2,694 catheter-days of observation. Six CLABSI events occurred (CICC: 4; PICC: 2). The CLABSI incidence rate was 1.79 per 1,000 catheter-days in the CICC group and 4.36 in the PICC group (hazard ratio, 8.65; 95% CI, 0.76-98.8; P=0.082). No CRT events occurred. At six months, CLABSI-free survival was 91.7% for CICCs and 50.0% for PICCs.
Conclusions: For bedridden patients for whom tunneled or implanted CVCs or PICCs are not feasible, CICCs may represent a potential option for long-term HPN. However, the small sample size, limited number of outcome events, and lack of multivariable adjustment warrant cautious interpretation and further study.
Reference:Oniwa M, Isono O, Kataoka Y. Long-Term Use of Non-tunneled Centrally Inserted Central Venous Catheters for Home Parenteral Nutrition in Bedridden Patients: A Retrospective Cohort Study. Cureus. 2026 Sep 7;18(9):e115881. doi: 10.7759/cureus.115881. PMID: 42846802; PMCID: PMC13643587.