The Thigh PICC: A Novel Approach to Long- term Vascular Access in Palliative Care - A Retrospective Study

The Thigh PICC: A Novel Approach to Long- term Vascular Access in Palliative Care - A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report The Thigh PICC: A Novel Approach to Long- term Vascular Access in Palliative Care - A Retrospective Study Baudolino Mussa, Maria Grazia Tammaro, Antonella Parisi, Barbara Defrancisco This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5717313/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Vascular access in palliative care presents unique challenges when traditional sites are unavailable. This study introduces and evaluates the thigh Peripherally Inserted Central Catheter (PICC), a novel approach for patients with compromised superior vena cava access [ 1 ]. Methods We conducted a retrospective analysis of clinical data from January 2017 to December 2021, examining outcomes of thigh PICC placements in palliative care patients. The technique involves ultrasound-guided placement in the common femoral vein with tunneling to a mid-thigh exit site [ 2 , 3 ]. Results 65 patients received thigh PICCs (67.7% female, 32.3% male; 43.1% ≤60 years). Primary indications were palliative care (35.4%), palliative chemotherapy (38.5%), and parenteral nutrition (18.5%) [ 4 ]. Median device duration was 4 months (range: 10 days to 42.1 months). Overall complication rate was 20%, including clinical thrombosis (7.7%) [ 8 ], infection (7.7%) [ 9 ], and mechanical complications (6.1%). Trial Registration Not applicable (retrospective study) Palliative care Vascular access PICC line Femoral vein Catheterization Thrombosis prevention [14] Cancer care [13] Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background In palliative care and advanced oncology, reliable vascular access is crucial for delivering treatments and maintaining quality of life [ 19 ]. Healthcare professionals frequently encounter situations where traditional vascular access sites are unavailable due to thrombosis [ 16 ], anatomical variations, or previous treatments. While guidelines suggest femoral venous catheters as an alternative when superior vena cava access is contraindicated [ 17 ], these carry significant risks, including a 25% chance of infection [ 18 ] or thrombosis. Methods Study Design We conducted a retrospective analysis of clinical data from January 1, 2017, to December 31, 2021, with a minimum follow-up period of 6 months for all patients [7]. The study was performed at the University of Turin following approval from the institutional ethics committee. Device and Technique The thigh PICC technique involves placement in the common femoral vein approximately 1 centimeter proximal to the saphenous junction. Devices used included: - BD NXT Groshong 4 Fr [11] - BD Power PICC Solo 4 Fr (single lumen) - BD Power PICC 5 Fr (dual lumen) - Teleflex Arrow PICC 5 Fr 45 cm (dual lumen) - Teleflex Arrow PICC 4 Fr 45 cm (single lumen) Patient Population The study included 65 patients requiring long-term vascular access [20]. Inclusion criteria were: - Need for medium to long-term vascular access - Contraindication or impossibility of superior vena cava access - Life expectancy >1 month - Informed consent [12] Data Collection We collected demographic data, insertion details, complications, and device duration following established protocols [15]. Complications were categorized as: - Infectious - Thrombotic - Mechanical Results Patient Demographics - Total patients: 65 - Gender: 67.7% female, 32.3% male - Age distribution: 43.1% ≤60 years, 56.9% >61 years Primary Indications - Palliative care only: 35.4% - Chemotherapy with palliative intent: 38.5% - Parenteral nutrition: 18.5% [17] - Other indications: 7.6% Device Outcomes - Median duration: 4 months (range: 10 days to 42.1 months) - 56.9% of patients died with device in situ - Overall complication rate: 20% - Clinical thrombosis: 7.7% [21] - Infection rate: 7.7% - Mechanical complications: 6.1% Discussion Compared to published data on standard PICCs [18], our thigh PICC technique showed higher rates of infection and thrombosis but lower mechanical complications. These differences likely reflect our complex patient population and reduced mobility rather than inherent technique limitations [16]. The technique's strengths include: - Low implantation complication rate (1.5%) [20] - Wide patient applicability - Improved quality of life through independent living [19] - Easier home care management Limitations include: - Higher infection and thrombosis rates versus standard PICCs - Limited long-term data - Potential underestimation of complications due to study design Conclusion The thigh PICC represents a viable alternative for long-term central venous access in palliative care patients where traditional access sites are unavailable. While complication rates exceed those of standard PICCs [21], they remain acceptable given the complex patient population and limited alternatives [22]. Future research should focus on optimizing the technique [23-24] and reducing complications through prospective studies. Declarations Ethics Approval and Consent to Participate The study was approved by the Città di Torino Ethics Committee (approval number: 25-c-4518/2023). Written informed consent was obtained from all participants. Consent for Publication Not applicable. Availability of Data and Materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' Contributions BM conceived and designed the study, performed procedures, and drafted the manuscript. MGT collected and analyzed data. AP contributed to study design and manuscript revision. BD performed statistical analysis. All authors read and approved the final manuscript. Acknowledgements We thank the nursing staff of our palliative care unit for their dedication to patient care and assistance with data collection. Authors' Information Not applicable. References Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med. 2014;3(4):80–94. Trottier SJ, Veremakis C, O'Brien J, Auer AI. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med. 1995;23(1):52–9. Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479–85. Sousa B, Furlanetto J, Hutka M, Gouveia P, Wuerstlein R, Mariz JM, et al. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol. 2015;26(Suppl 5):v152-68. Ostroff MD, Moureau N, Pittiruti M. Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients. J Vasc Access. 2021 Jul 21:11297298211034306. Powers CJ, Mondschein JI. Translumbar inferior vena cava catheters for long-term venous access. J Vasc Interv Radiol. 1998;9(6):1021–5. Woerner A, Wenger JL, Monroe EJ. Single-access ultrasound-guided tunneled femoral lines in critically ill pediatric patients. J Vasc Access. 2020;21(6):1034–41. Geerts W. Central venous catheter-related thrombosis. Hematology Am Soc Hematol Educ Program. 2014;2014(1):306–11. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-93. Alpenberg S, Joelsson G, Rosengren K. Feeling confident in using PICC lines: Patients' experiences of living with a PICC line during chemotherapy treatment. Home Health Care Manag Pract. 2015;27(3):119–25. Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V, et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet. 2015;386(10008):2069–77. Moureau N, Lamperti M, Kelly LJ, Dawson R, Elbarbary M, van Boxtel AJ, et al. Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. Br J Anaesth. 2013;110(3):347–56. Taxbro K, Hammarskjöld F, Thelin B, Lewin F, Hagman H, Hanberger H, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth. 2019;122(6):734–41. Chopra V, Kaatz S, Conlon A, Patel PJ, Grant PJ, Rogers MAM, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemost. 2017;15(10):1951–62. Mermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis. 2011;52(2):211–2. Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712–23. Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28(4):365–77. Chopra V, O'Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013;34(9):908–18. LeBlanc TW, Abernethy AP. Patient-reported outcomes in cancer care - hearing the patient voice at greater volume. Nat Rev Clin Oncol. 2017;14(12):763–72. Ullman AJ, Bulmer AC, Dargaville TR, Rickard CM, Chopra V. Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety. Expert Rev Med Devices. 2019;16(1):25–33. Campagna S, Gonella S, Berchialla P, Morano G, Rigo C, Zerla PA, et al. Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days. Oncologist. 2019;24(9):e953-9. Yuan L, Li R, Meng A, Feng Y, Wu X, Yang Y, et al. Superiority of prophylactic modified catheter over standard catheter for peripheral intravenous catheterization in cancer patients receiving chemotherapy: A randomized controlled trial. Int J Nurs Stud. 2023;138:104398. Takashima M, Slim A, Moscova M, Gosbell IB, Jensen SO, et al. Randomized Controlled Trial Evaluating the Effectiveness of Vascular Access Surveillance with Ultrasound in Reducing Central Line-Associated Bloodstream Infection. Ann Surg. 2022;276(4):708–714. Smith JM, Reeves TR, Morris PE, Reeves BC. Reducing Vascular Access Complications: An Evidence-Based Approach to Improving Practice. JAVA. 2023;28(2):42–51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5717313","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":415696649,"identity":"867c144e-8e54-493b-9c9b-d83200f81b3e","order_by":0,"name":"Baudolino 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2","display":"","copyAsset":false,"role":"figure","size":180473,"visible":true,"origin":"","legend":"\u003cp\u003eInitial catheter insertion at femoral site\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/8a1b8c559f5492323801ea74.jpg"},{"id":76568522,"identity":"4fba8d40-0bc2-4472-9f57-b43ca761c747","added_by":"auto","created_at":"2025-02-18 13:14:31","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":219711,"visible":true,"origin":"","legend":"\u003cp\u003eTunneling procedure initiation\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/6ed9c9e0ab860c622f5dbd6d.jpg"},{"id":76567332,"identity":"e8f5303f-6462-4186-bb71-d2582492940a","added_by":"auto","created_at":"2025-02-18 13:06:31","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":229132,"visible":true,"origin":"","legend":"\u003cp\u003eMid-thigh tunnel creation\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/abbde358e4596ab6cb781ba4.jpg"},{"id":76568783,"identity":"f16d923e-f052-428f-9c00-3d61fbed65f4","added_by":"auto","created_at":"2025-02-18 13:22:31","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":209522,"visible":true,"origin":"","legend":"\u003cp\u003eCatheter advancement through tunnel\u003c/p\u003e","description":"","filename":"Fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/fe85b49614407ddf75db5420.jpg"},{"id":76568787,"identity":"82a7e497-73a0-4413-97e7-09bff2d01a94","added_by":"auto","created_at":"2025-02-18 13:22:31","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":252231,"visible":true,"origin":"","legend":"\u003cp\u003eExit site preparation\u003c/p\u003e","description":"","filename":"Fig6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/9f718f4a619644a706863502.jpg"},{"id":76568529,"identity":"321fb761-cb78-46df-98c3-d8d1eb88c6e3","added_by":"auto","created_at":"2025-02-18 13:14:32","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":206743,"visible":true,"origin":"","legend":"\u003cp\u003eFinal catheter positioning\u003c/p\u003e","description":"","filename":"Fig7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/3b78e52b2800eaff9cefa2dd.jpg"},{"id":76567348,"identity":"676b8d1d-e6ba-4d22-8f34-331b94cec742","added_by":"auto","created_at":"2025-02-18 13:06:32","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":221000,"visible":true,"origin":"","legend":"\u003cp\u003eCompleted insertion with secured catheter\u003c/p\u003e","description":"","filename":"Fig8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/d765881ef5cd43c297264e97.jpg"},{"id":76570804,"identity":"959da0e1-09f5-4242-a854-1e125ef4a3aa","added_by":"auto","created_at":"2025-02-18 13:38:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2149801,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5717313/v1/998b5ab5-a277-4d09-bf56-ff147bce8813.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Thigh PICC: A Novel Approach to Long- term Vascular Access in Palliative Care - A Retrospective Study","fulltext":[{"header":"Background","content":"\u003cp\u003eIn palliative care and advanced oncology, reliable vascular access is crucial for delivering treatments and maintaining quality of life [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Healthcare professionals frequently encounter situations where traditional vascular access sites are unavailable due to thrombosis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], anatomical variations, or previous treatments. While guidelines suggest femoral venous catheters as an alternative when superior vena cava access is contraindicated [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], these carry significant risks, including a 25% chance of infection [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] or thrombosis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective analysis of clinical data from January 1, 2017, to December 31, 2021, with a minimum follow-up period of 6 months for all patients [7]. The study was performed at the University of Turin following approval from the institutional ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevice and Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe thigh PICC technique involves placement in the common femoral vein approximately 1 centimeter proximal to the saphenous junction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevices used included:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- BD NXT Groshong 4 Fr [11]\u003c/p\u003e\n\u003cp\u003e- BD Power PICC Solo 4 Fr (single lumen)\u003c/p\u003e\n\u003cp\u003e- BD Power PICC 5 Fr (dual lumen)\u003c/p\u003e\n\u003cp\u003e- Teleflex Arrow PICC 5 Fr 45 cm (dual lumen)\u003c/p\u003e\n\u003cp\u003e- Teleflex Arrow PICC 4 Fr 45 cm (single lumen)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 65 patients requiring long-term vascular access [20]. Inclusion criteria were:\u003c/p\u003e\n\u003cp\u003e- Need for medium to long-term vascular access\u003c/p\u003e\n\u003cp\u003e- Contraindication or impossibility of superior vena cava access\u003c/p\u003e\n\u003cp\u003e- Life expectancy \u0026gt;1 month\u003c/p\u003e\n\u003cp\u003e- Informed consent [12]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe collected demographic data, insertion details, complications, and device duration following established protocols [15]. Complications were categorized as:\u003c/p\u003e\n\u003cp\u003e- Infectious\u003c/p\u003e\n\u003cp\u003e- Thrombotic\u003c/p\u003e\n\u003cp\u003e- Mechanical\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Demographics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Total patients: 65\u003c/p\u003e\n\u003cp\u003e- Gender: 67.7% female, 32.3% male\u003c/p\u003e\n\u003cp\u003e- Age distribution: 43.1% ≤60 years, 56.9% \u0026gt;61 years\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Indications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Palliative care only: 35.4%\u003c/p\u003e\n\u003cp\u003e- Chemotherapy with palliative intent: 38.5%\u003c/p\u003e\n\u003cp\u003e- Parenteral nutrition: 18.5% [17]\u003c/p\u003e\n\u003cp\u003e- Other indications: 7.6%\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevice Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e- Median duration: 4 months (range: 10 days to 42.1 months)\u003c/p\u003e\n\u003cp\u003e- 56.9% of patients died with device in situ\u003c/p\u003e\n\u003cp\u003e- Overall complication rate: 20%\u003c/p\u003e\n\u003cp\u003e- Clinical thrombosis: 7.7% [21]\u003c/p\u003e\n\u003cp\u003e- Infection rate: 7.7%\u003c/p\u003e\n\u003cp\u003e- Mechanical complications: 6.1%\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCompared to published data on standard PICCs [18], our thigh PICC technique showed higher rates of infection and thrombosis but lower mechanical complications. These differences likely reflect our complex patient population and reduced mobility rather than inherent technique limitations [16].\u003c/p\u003e\n\u003cp\u003eThe technique\u0026apos;s strengths include:\u003c/p\u003e\n\u003cp\u003e- Low implantation complication rate (1.5%) [20]\u003c/p\u003e\n\u003cp\u003e- Wide patient applicability\u003c/p\u003e\n\u003cp\u003e- Improved quality of life through independent living [19]\u003c/p\u003e\n\u003cp\u003e- Easier home care management\u003c/p\u003e\n\u003cp\u003eLimitations include:\u003c/p\u003e\n\u003cp\u003e- Higher infection and thrombosis rates versus standard PICCs\u003c/p\u003e\n\u003cp\u003e- Limited long-term data\u003c/p\u003e\n\u003cp\u003e- Potential underestimation of complications due to study design\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe thigh PICC represents a viable alternative for long-term central venous access in palliative care patients where traditional access sites are unavailable. While complication rates exceed those of standard PICCs [21], they remain acceptable given the complex patient population and limited alternatives [22]. Future research should focus on optimizing the technique [23-24] and reducing complications through prospective studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to Participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Città di Torino Ethics Committee (approval number: 25-c-4518/2023). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors' Contributions\u003c/p\u003e\n\u003cp\u003eBM conceived and designed the study, performed procedures, and drafted the manuscript. MGT collected and analyzed data. AP contributed to study design and manuscript revision. BD performed statistical analysis. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe thank the nursing staff of our palliative care unit for their dedication to patient care and assistance with data collection.\u003c/p\u003e\n\u003cp\u003eAuthors' Information\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med. 2014;3(4):80\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrottier SJ, Veremakis C, O'Brien J, Auer AI. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med. 1995;23(1):52\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSousa B, Furlanetto J, Hutka M, Gouveia P, Wuerstlein R, Mariz JM, et al. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol. 2015;26(Suppl 5):v152-68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOstroff MD, Moureau N, Pittiruti M. Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients. J Vasc Access. 2021 Jul 21:11297298211034306.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowers CJ, Mondschein JI. Translumbar inferior vena cava catheters for long-term venous access. J Vasc Interv Radiol. 1998;9(6):1021\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoerner A, Wenger JL, Monroe EJ. Single-access ultrasound-guided tunneled femoral lines in critically ill pediatric patients. J Vasc Access. 2020;21(6):1034\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeerts W. Central venous catheter-related thrombosis. Hematology Am Soc Hematol Educ Program. 2014;2014(1):306\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlpenberg S, Joelsson G, Rosengren K. Feeling confident in using PICC lines: Patients' experiences of living with a PICC line during chemotherapy treatment. Home Health Care Manag Pract. 2015;27(3):119\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V, et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet. 2015;386(10008):2069\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoureau N, Lamperti M, Kelly LJ, Dawson R, Elbarbary M, van Boxtel AJ, et al. Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. Br J Anaesth. 2013;110(3):347\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaxbro K, Hammarskj\u0026ouml;ld F, Thelin B, Lewin F, Hagman H, Hanberger H, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth. 2019;122(6):734\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChopra V, Kaatz S, Conlon A, Patel PJ, Grant PJ, Rogers MAM, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemost. 2017;15(10):1951\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis. 2011;52(2):211\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTimp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28(4):365\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChopra V, O'Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013;34(9):908\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeBlanc TW, Abernethy AP. Patient-reported outcomes in cancer care - hearing the patient voice at greater volume. Nat Rev Clin Oncol. 2017;14(12):763\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUllman AJ, Bulmer AC, Dargaville TR, Rickard CM, Chopra V. Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety. Expert Rev Med Devices. 2019;16(1):25\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampagna S, Gonella S, Berchialla P, Morano G, Rigo C, Zerla PA, et al. Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days. Oncologist. 2019;24(9):e953-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan L, Li R, Meng A, Feng Y, Wu X, Yang Y, et al. Superiority of prophylactic modified catheter over standard catheter for peripheral intravenous catheterization in cancer patients receiving chemotherapy: A randomized controlled trial. Int J Nurs Stud. 2023;138:104398.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakashima M, Slim A, Moscova M, Gosbell IB, Jensen SO, et al. Randomized Controlled Trial Evaluating the Effectiveness of Vascular Access Surveillance with Ultrasound in Reducing Central Line-Associated Bloodstream Infection. Ann Surg. 2022;276(4):708\u0026ndash;714.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith JM, Reeves TR, Morris PE, Reeves BC. Reducing Vascular Access Complications: An Evidence-Based Approach to Improving Practice. JAVA. 2023;28(2):42\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Palliative care, Vascular access, PICC line, Femoral vein, Catheterization, Thrombosis prevention [14], Cancer care [13]","lastPublishedDoi":"10.21203/rs.3.rs-5717313/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5717313/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVascular access in palliative care presents unique challenges when traditional sites are unavailable. This study introduces and evaluates the thigh Peripherally Inserted Central Catheter (PICC), a novel approach for patients with compromised superior vena cava access [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We conducted a retrospective analysis of clinical data from January 2017 to December 2021, examining outcomes of thigh PICC placements in palliative care patients. The technique involves ultrasound-guided placement in the common femoral vein with tunneling to a mid-thigh exit site [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e65 patients received thigh PICCs (67.7% female, 32.3% male; 43.1% \u0026le;60 years). Primary indications were palliative care (35.4%), palliative chemotherapy (38.5%), and parenteral nutrition (18.5%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Median device duration was 4 months (range: 10 days to 42.1 months). Overall complication rate was 20%, including clinical thrombosis (7.7%) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], infection (7.7%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and mechanical complications (6.1%).\u003c/p\u003e\u003ch2\u003eTrial Registration\u003c/h2\u003e \u003cp\u003eNot applicable (retrospective study)\u003c/p\u003e","manuscriptTitle":"The Thigh PICC: A Novel Approach to Long- term Vascular Access in Palliative Care - A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-18 13:06:26","doi":"10.21203/rs.3.rs-5717313/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6e1e64a-ca1a-490c-bbf4-8399fc9dcfdd","owner":[],"postedDate":"February 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-26T10:32:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-18 13:06:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5717313","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5717313","identity":"rs-5717313","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}