- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03674216
Study of Peripherally Inserted Venous Catheters in Cystic Fibrosis Patients (PICC-CF)
April 8, 2022 updated by: Jonathan B. Zuckerman
Prospective Study of Peripherally Inserted Venous Catheters in CF Patients
According to the U.S. CF Foundation Patient Registry, more than 25% of children and 40% of adults were treated with intravenous (IV) antibiotics for flares of lung disease in 2016.
Medication for these flares is often delivered through a peripherally inserted central catheter (PICC).
Case series have identified important complications of PICCs in CF patients such as blood clots and infection.
The frequency of PICC-associated blood clots in CF patients ranges from 2 to 8%.
Catheter-related complications may interfere with completion of therapy and lead to repeated procedures and other complex medical treatments.
In some cases PICC complications may discourage patients from accepting future courses of IV antibiotics.
Therefore, it is very important to identify patient- and device-related factors that are linked with more frequent complications and to figure out ways to reduce these risks.
Proposed risk factors fall into several broad categories.
First are catheter-related factors; second are patient factors; and third are catheter-management factors.
To date, no multicenter trial has carefully studied PICC complications in a large group of adult and pediatric CF patients from the time each catheter is placed to when it is removed.
The main purpose of this study is to see whether the investigators can identify important factors in each of the three categories (patient, catheter, and catheter management) that are linked to various complications.
Study Overview
Status
Completed
Conditions
Detailed Description
According to data from the U.S. CF Foundation Patient Registry (CFFPR), more than 25% of children and 40% of adults were treated with intravenous (IV) antibiotics for pulmonary exacerbations (PEx) in 2016; this translated to 20,286 care episodes.
Case series have identified important complications of PICCs and TIVADs in CF patients such as deep venous thrombosis (DVT) and infection; central venous stenosis; and other types of mechanical dysfunction.
The incidence of PICC-associated DVT in CF patients ranges from 2 to 8%.
Proposed risk factors in CF patients fall into several broad categories.
First are catheter-related factors: larger catheter size, number of catheter lumens, and catheter composition; second are patient factors: lung function, nutritional status, respiratory flora, diabetes status, thrombophilia; and number of previously placed catheters; and third are catheter-management factors: insertion technique and site selection, inpatient versus outpatient care, anticoagulant use, blood sampling practices, and duration of line use.
The importance of some of these factors remains controversial, leading some to call for detailed prospective studies of PICC use in specific patient populations.
To date, no multicenter trial has prospectively studied PICC and midline complications in adult and pediatric CF patients.
The investigators hypothesize that the rate of PICC and midline vascular complications is associated with specific patient level and line level factors as well as with line insertion and management practices.
The proposed trial is a multicenter, prospective surveillance study to evaluate (patient level-, catheter level- and catheter management-) risk factors associated with various complications of PICCs and midlines in pediatric and adult CF patients.
Study Type
Observational
Enrollment (Actual)
260
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Maine
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Portland, Maine, United States, 040102
- Maine Medical Center
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
6 years and older (Child, Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Non-Probability Sample
Study Population
Pediatric and adult cystic fibrosis patients
Description
Inclusion Criteria:
- All ethnic groups
- Females and males
- 6 years of age and above (in order to perform spirometry on all study participants)
- Undergoing treatment for PEx with IV antibiotics via hospital-placed PICC or midline catheter
- Ability to communicate with pertinent staff.
- Ability to understand and willingness to comply with the requirements of the trial (allow repeated assessment of the catheter insertion site, photographs of the site, extremity measurement and face-to face assessment on the day of line removal).
- Ability and willingness to give verbal consent (with the assistance of a parent or guardian, if appropriate) or assent (for pediatric patients)
Diagnosis of cystic fibrosis consisting of both:
- sweat sodium or chloride > 60 mEq/L by the pilocarpine iontophoresis method or cystic fibrosis genotype (homozygous for CFTR mutation or compound heterozygous for CFTR mutations)
- clinical manifestations of cystic fibrosis
Exclusion Criteria:
- Under age 6
- Planned use of a TIVAD or peripheral catheter for IV therapy for the full course of therapy
- History of >10 PICCs prior to study entry
- IV treatment anticipated to extend beyond 21 days at the time of line insertion
- Patient taking anticoagulant medication (other than NSAIDs) at the time of screening
- Inability/unwillingness to provide consent or assent
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Case-Only
- Time Perspectives: Prospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Development of catheter related deep venous thrombosis or catheter occlusion
Time Frame: While the catheter is in place, an average of two weeks
|
Occlusion of the catheter requiring removal or symptomatic venous thrombosis in the extremity with the line as indicated by a Constans Clinical Decision Score greater than or equal to 2. The range of the scale goes from -1 to 3 with higher scores representing worse outcome.
One point is added to a baseline score of 0 for each of the following: indwelling venous material, localized pain, unilateral pitting edema.
One point is subtracted for another diagnosis being at least as plausible as venous thrombosis.
|
While the catheter is in place, an average of two weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Development of catheter related local phlebitis or superficial thrombophlebitis
Time Frame: While the catheter is in place, an average of two weeks
|
Phlebitis as defined by a Visual Infusion Phlebitis (VIP) score greater than or equal to 2. The range of the scale goes from 0 to 5 with higher scores representing worse outcome.
The values on the VIP scale are defined as follows: 0-site appears healthy; 1- One of the following: Pain near the IV site or erythema near the IV site; 2- Two of the following: Pain or erythema or swelling near the IV site; 3- All of the following: Pain, erythema, and induration near the IV site; 4- All of the following: Pain, erythema, and palpable venous cord near the IV site; 5- All of the following: Pain, erythema, palpable venous cord and fever >38 degrees centigrade.
Thrombophlebitis is defined by phlebitis associated with superficial thrombosis as detected by ultrasound or venogram.
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While the catheter is in place, an average of two weeks
|
Central line associated blood stream infection (CLABSI)
Time Frame: While the catheter is in place, an average of two weeks
|
The study definition for CLABSI follows the Centers for Disease Control guidelines
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While the catheter is in place, an average of two weeks
|
Number of participants with catheter associated deep venous thrombosis
Time Frame: While the catheter is in place, an average of two weeks
|
Deep venous thrombosis as confirmed by ultrasound and/or venogram
|
While the catheter is in place, an average of two weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients with catheter associated hematoma or bleeding
Time Frame: While the catheter is in place, an average of two weeks
|
Visible bruising associated with the catheter insertion site, bleeding from the catheter insertion site or incident hemoptysis
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While the catheter is in place, an average of two weeks
|
Number of patients with catheter associated site pain
Time Frame: While the catheter is in place, an average of two weeks
|
Pain in the extremity associated with the catheter
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While the catheter is in place, an average of two weeks
|
Number of patients with catheter fracture
Time Frame: While the catheter is in place, an average of two weeks
|
Catheter fracture
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While the catheter is in place, an average of two weeks
|
Number of patients with temporary occlusion of the catheter
Time Frame: While the catheter is in place, an average of two weeks
|
Temporary occlusion of the catheter cleared by thrombolytic agent
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While the catheter is in place, an average of two weeks
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Catheter associated change in arm circumference
Time Frame: While the catheter is in place, an average of two weeks
|
Arm circumference in centimeters (cm) measured 5 cm distal to the catheter insertion site
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While the catheter is in place, an average of two weeks
|
Serum C-reactive protein concentration
Time Frame: While the catheter is in place, an average of two weeks
|
Serum measure of inflammatory status with samples taken at the time of catheter insertion and removal
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While the catheter is in place, an average of two weeks
|
Serum D-dimer concentration
Time Frame: While the catheter is in place, an average of two weeks
|
Blood test to assess coagulation status with samples taken at the time of catheter insertion.
|
While the catheter is in place, an average of two weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Jonathan Zuckerman, M.D., MaineHealth
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
November 12, 2018
Primary Completion (Actual)
June 30, 2021
Study Completion (Actual)
June 30, 2021
Study Registration Dates
First Submitted
September 12, 2018
First Submitted That Met QC Criteria
September 13, 2018
First Posted (Actual)
September 17, 2018
Study Record Updates
Last Update Posted (Actual)
April 11, 2022
Last Update Submitted That Met QC Criteria
April 8, 2022
Last Verified
April 1, 2022
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1223366
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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