From the Research
Brachiocephalic PICC placement carries higher risks compared to peripheral PICC lines, and therefore, peripheral PICC placement is recommended for most patients requiring long-term intravenous therapy. The main concerns with brachiocephalic placement include increased risk of central vein thrombosis, catheter malposition, arterial puncture, pneumothorax, and cardiac arrhythmias due to proximity to the heart. In contrast, peripheral PICC lines, typically placed in the basilic, brachial, or cephalic veins of the arm, generally have lower complication rates, as shown in a study published in 2022 1. This study found that the overall complication rate for PICCs was 15.2%, with catheter occlusion being the most prevalent complication.
Some of the key complications associated with PICC placement include:
- Infection, such as catheter-related bloodstream infection or central line-associated bloodstream infection
- Thrombosis, including deep vein thrombosis or pulmonary embolism
- Mechanical complications, such as occlusion, accidental withdrawal, or malposition
- Phlebitis, which can occur with peripheral PICC placement
A study published in 2017 2 found that the overall complication rate for PICCs was 30.2%, with occlusion and accidental withdrawal being the most common complications. Another study published in 2019 3 emphasized the importance of proper insertion technique and ongoing care to prevent complications.
The choice between placement sites should consider patient anatomy, expected duration of therapy, and specific medical needs. For example, a study published in 2015 4 found that age over 70 years and the number of lumens in the PICC were significant risk factors for complications.
Overall, while both brachiocephalic and peripheral PICC placements have their own set of risks and benefits, peripheral PICC placement is generally considered the safer option for most patients requiring long-term intravenous therapy, due to its lower risk of serious complications such as pneumothorax and cardiac arrhythmias.