Short-Term Use of PICCs Holds Certain Risk

A new study concludes that although short-term use of peripherally inserted central catheters (PICCs) is common, it does not warrant the potential hazards they pose.

Researchers at the University of Michigan (U-M; Ann Arbor, USA), Henry Ford Hospital (Detroit, MI, USA), and other institutions collected data from the medical records of 15,397 adults who received PICCs during their hospitalization in order to identify patient, provider, and device characteristics, and investigate clinical outcomes associated with short-term PICCs. The study was conducted between January 2014 and June 2016, with patients prospectively followed until PICC removal, death, or 70 days after insertion.

The results revealed that 25.3% had a PICC dwell time of up to five days, with most short-term PICCs removed during hospitalization. Compared to PICCs placed for longer than five days, variables related with short-term PICCs included difficult venous access, multi-lumen devices, and teaching hospitals. Among those with short-term PICCs, 9.6% experienced a complication, including 2.5% that experienced venous thromboembolism (VTE), and 0.4% that experienced a central line associated bloodstream infection (CLABSI) event. The most common minor complications were catheter occlusion (4%) and tip migration (2.2%). The study was published in the February 2018 issue of Hospital Medicine.

“When PICCs first came out, they became an 'easy button' for vascular access, and the safety issues weren't recognized. The use of PICCs exploded because the safety issues were not initially recognized, including those associated with clots and infections,” said lead author David Paje, MD, MPH, of U-M. “We're coming back full circle, and we need to adapt and implement quality improvement processes to be more judicious with their use. We need to recognize that PICCs are not without any consequence, even for short-term use.”

PICCs have become the preferred device through which to administer long-term intravenous (IV) fluids, antibiotics, and other drugs because they have lower risks of infection, can be conveniently placed at the bedside, and can stay in place for long periods of time. The ability to keep PICCs in for weeks or even months also allows patients who need a constant flow of medications to go home with these catheters.

Related Links:
University of Michigan
Henry Ford Hospital