From the Guidelines
Peripherally Inserted Central Catheter (PICC) lines should not be placed in patients with certain conditions that increase risks of complications, including recent history of thrombosis, bacteremia or sepsis, burns or infections at the insertion site, superior vena cava syndrome, and known thrombosis in the target vein, as stated in the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 1. The contraindications for PICC line placement can be categorized into absolute and relative contraindications. Absolute contraindications include:
- Bacteremia or sepsis
- Burns or infections at the insertion site
- Superior vena cava syndrome
- Known thrombosis in the target vein Relative contraindications include:
- Coagulopathy (INR >1.5, platelets <50,000/mm³)
- Recent mastectomy or lymph node dissection on the side of insertion
- Presence of a pacemaker or defibrillator wires
- Arm dialysis grafts or fistulas
- Severe peripheral vascular disease
- Chronic kidney disease (eGFR <45 ml/min) who may need future dialysis access
- History of venous thromboembolism or hypercoagulable states According to the MAGIC guide, placement of a PICC was specifically rated as inappropriate if the indication for insertion was 1) frequent phlebotomy when peripheral access was available, or 2) patient request for comfort in non–end-of-life settings 1. The use of PICCs can lead to serious complications, including infection, thrombosis, and vein damage, especially in high-risk patients. Therefore, alternative vascular access options should be considered in these cases, such as peripheral IVs, midline catheters, or centrally inserted central catheters, depending on the clinical situation 1. Some key considerations for PICC placement include:
- The presence of a suitable vein or site of insertion for PICC
- The need for episodic infusions over several months
- The risk of thrombosis and the need for anticoagulation
- The presence of a history of venous thromboembolism or hypercoagulable states
- The need for careful consideration of the risks and benefits of PICC placement in patients with certain conditions.
From the Research
PICC Line Contraindications
The following are contraindications for Peripherally Inserted Central Catheter (PICC) line placement:
- Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), as they are at a higher risk of complications such as phlebitis, thrombosis, and central vein stenosis 2
- Patients with solid tumors, as they have a higher rate of complications such as sepsis, thrombosis, and blockage 3
- Patients with malnutrition, as it is associated with an increased risk of complications 4
- Patients with a body mass index (BMI) greater than 30, as it is associated with an increased risk of complications 4
- Patients who require after-hours placement, as it is associated with an increased risk of complications 4
- Patients with orthopedic infections who are older than 70 years, as age is a significant risk factor for complications 5
- Patients who require multiple lumen PICCs, as the increasing number of lumens is a potential risk factor for complications 5
Relative Contraindications
The following are relative contraindications for PICC line placement:
- Patients with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE), as they may be at a higher risk of thromboembolic complications
- Patients with active infection or sepsis, as they may be at a higher risk of infectious complications
- Patients with compromised venous access, as they may be at a higher risk of mechanical complications
Special Considerations
The following are special considerations for PICC line placement:
- Patients with CKD and ESKD should be educated on the importance of preserving their venous access for future hemodialysis 2
- Patients with solid tumors should be closely monitored for signs of complications such as sepsis and thrombosis 3
- Patients with malnutrition and BMI greater than 30 should be screened for potential complications and managed accordingly 4