From the Guidelines
PICC lines are associated with significant risks, including infection, thrombosis, and mechanical complications, and their use should be carefully considered and monitored. The most common risks include infection, which can range from local site infections to serious bloodstream infections like sepsis 1. Blood clots (thrombosis) may form around the catheter, potentially leading to deep vein thrombosis or pulmonary embolism. Mechanical complications can occur, such as catheter migration, breakage, or occlusion that prevents proper functioning. Air embolism is a rare but serious risk if air enters the line during insertion or maintenance. PICC lines can also cause vein irritation or phlebitis, and there's a small risk of nerve injury during insertion.
Some key points to consider when using PICC lines include:
- The choice of central venous catheter type and location of exit site should be made by a multidisciplinary team, along with an experienced specialist and the patient 1.
- Right-sided access is preferable to a left-sided approach with respect to risk for thrombotic complications 1.
- The tip of the catheter should be placed at the level of the right atrial-superior vena cava junction 1.
- The exit site of the catheter should be easily visualized and accessible for patients doing self-care 1.
- Tunneled CVCs or totally implanted devices are recommended for long-term use, rather than PICC lines, due to the higher risk of thrombosis and issues related to self-administration of therapy 1.
To minimize the risks associated with PICC lines, strict aseptic technique during insertion and maintenance is essential, along with regular assessment of the insertion site for signs of infection or complications. Patients should report any fever, chills, pain, swelling, or redness at the insertion site immediately. Despite these risks, PICC lines remain valuable for long-term intravenous therapy when properly managed with appropriate precautions 1.
From the Research
Picc Line Risks
- The use of Peripherally Inserted Central Catheters (PICCs) is associated with several risks, including infection, thrombosis, and mechanical complications 2, 3, 4, 5, 6.
- A prospective cohort study found that the overall complication rate for PICCs was 30.2%, with occlusion and accidental withdrawal being the most common complications 2.
- The study also found that the complication rate was higher in the hospitalization setting (36.1%) than in the outpatient setting (19.4%) 2.
- Multivariate logistic regression analysis showed that the occurrence of occlusion was significantly associated with an age > 65 years and the presence of a pre-occlusive event the week before PICC removal 2.
- Another study found that PICC lines are related to some complications, including bloodstream infections, and that their use should be indicated in specific clinical conditions due to low infectious rates 3.
- A review of the literature found that PICCs may not be as innocuous as once thought, and that there is a growing body of evidence suggesting that these devices have important risks, including venous thrombosis and bloodstream infections 4.
- A retrospective review of PICC complications in patients with solid tumours found a high rate of complications, including sepsis, thrombosis, blockage, and leakage, and that PICC lines should be used with caution in these patients 5.
- Imaging studies have also identified several complications related to PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture 6.