| Abstrakt: |
One of the issues noted during home palliative treatments is the staggering amount of patients with poor venous access due to the "butchered" state of their arms caused by previous intravenous therapies or attempts at therapies. The aim of the present work was to demonstrate the feasibility of home placement of peripherally inserted central catheters and midline catheters in aged bedridden patients who cannot be taken to hospital. The patients were chosen on the basis of a codified procedure which took into account their clinical condition (such as mobility level and Karnofsky index) as well as the hygienic conditions of their homes. In a three-year period, 150 successful insertions were performed at home in patients aged over 80 (97 women and 53 men) affected by various diseases and in need of continuous infusion therapy, parenteral nutrition, or blood transfusions. One hundred eleven patients had peripherally inserted central catheters and 39 midline catheters. The basilica vain was used in 99 cases. Cancer was the most frequent underlying condition (63 patients) followed by Alzheimer disease (37 patients), whereas the need for infusion therapy was the most frequent indication (129 patients). The mean duration was 41 days (50 for peripherally inserted central catheters and 15 for midline catheters). Death was the most frequent reason for catheter removal, followed by involuntary removal. Twelve complications occurred, with thrombosis being the most frequent, followed by infections and catheter malfunctioning. Based on these findings, it can be concluded that age does not affect the outcome of home placement of peripherally inserted central catheters and midline catheters. Moreover, the home is the ideal place to carry out peripherally inserted central catheter and midline insertion because undesirable hospitalization is avoided. Finally, these devices are able to improve quality of life in patients aged over 80 although this specific issue needs further investigation. The ratio between the use of peripherally inserted central catheters and/or midlines versus the use of traditional peripheral cannulas for venous assess was 1:14 in the author's personal series (6106 days of catheters in situ). This should prompt more use of peripherally inserted central catheters and midline catheters, given the more favorable cost-effectiveness ratio. [ABSTRACT FROM AUTHOR] |
