Prolonging the Duration on Site of Short Peripheral Venous Catheters Used to Administer Intravenous Antibiotics in Cystic Fibrosis Adults. Randomized Controlled Trial on the Effect of Different Concentrations of Antibiotic in Normal Saline

Background

Cystic Fibrosis (CF) is a common genetic disease which affects, among other organs, the respiratory tree. The major cause of mortality and morbidity in CF are pulmonary infections caused by a limited number of bacteria, in particular gram negative bacteria such as Pseudomonas aeruginosa (PA) and Burkholderia cepacia complex (BCC) which cause frequent clinically acute pulmonary infections.

Current figures show that 57.3% of patient have their lungs infected by PA and 2.9% of them have their lungs infected by BCC (1). To fight pulmonary exacerbations, patients frequently have to undergo antibiotic treatments, which often cannot be given orally or by aerosol but have to be administered intravenously (IV). Some CF Centers have also adopted a treatment protocol for patients chronically infected by respiratory pathogens in which a prophylactic IV course of antibiotic is routinely given every 3 months even in the absence of clinical symptoms of pulmonary exacerbations (2) An IV course of antibiotic treatment should be continued for at least 10 days but usually it lasts 2 weeks (3). Completing it would therefore require doing numerous venipunctures to a patient. In the USA, during 2004 some 45% of patients aged 18 to 30 required at least 1 IV antibiotic course, about 25% 2 IKV course and 15% 3 courses or more (1). This IV treatment regime brings a relevant burden of pain, anxiety and a worsening of quality of life (4). In order to reduce the number of venipunctures needed for an antibiotic course, several intravenous indwelling devices have been used to administer antibiotic infusion.

Some of these venous catheters are inserted in a central vessel. Among them, port caths and Groshong or Broviac type Central catheters, Midline catheters are those most commonly used (5-9). They are intended to last from several weeks to years. Their insertion requires a surgical intervention. Such an invasive intervention may not be sometimes indicated due to the patient's clinical condition. Moreover, the presence of a permanent device may influence the patients' body image and autonomy, with negative consequences in the psychological condition of the patient, especially in adolescence (10). Also, systemic infections may occur (11), the permanent management of the device may result complicated (12-15) and it may influence the patient's day-to-day life. Recently, a high incidence of thrombosis related to the insertion of this kind of catheters has been described (16) The most commonly used type of IV device to administer antibiotics in CF is the short peripheral venous catheter (SPVC) or cannula (17, 18) which has been considered for long now the simplest, most easy-to-use and economic way for administering IV therapy in CF. The use of this device allows patients not to be punctured at every administration and to eventually perform the antibiotic course at home avoiding hospitalisation and therefore maintaining a relatively normal daily life. Moreover, compared to the previously described permanent devices, this one is less invasive, it does not require a surgical intervention to be inserted, and it is intended to be maintained only for the duration of the treatment.

In order to facilitate CF people's autonomy and to reduce the conditioning of their quality of life, The home administration of IV antibiotic has become increasingly common (17-21). In 2004, 20.1% of US CF patients received home IV treatment (1). Patients themselves and their relatives are often trained by CF Centers' Nurses on how to manage the administration of the antibiotic treatment on their own.