Perils of the PICC: Uncovering Risks & Preventing Complications

Study Overview
Peripherally inserted central catheters (PICCs) are widely used for medium-term vascular access, especially in oncology and critical care. While often perceived as safer than traditional central venous catheters (CVCs), this narrative review reveals a different picture—highlighting the high rate of complications associated with PICCs, ranging from bloodstream infections to thrombosis and malpositioning.

Key Findings

• Higher Complication Rates: Overall PICC-associated complications range from 9.5% to 38.6%, which is significantly higher than that of centrally inserted CVCs.
• Serious Risks: Life-threatening complications like CLABSI (1.4-1.9%) and thrombosis (2.3-5.9%) are more frequent in PICC patients.
• Risk Factors: Patients with higher BMI, diabetes, renal failure, or malignancy are more likely to experience complications.
• Design Trade-offs: Antimicrobial-coated and valved PICCs show mixed results in reducing infections or occlusions. Multi-lumen PICCs also increase risk.
• Pediatric Vulnerability: Complication rates in children can reach 41%, with risk factors including young age, intensive care admission, and frequent device access.
• Tunnelled PICCs Perform Better: Tunnelled designs show fewer infections and dislodgements in multiple studies.
• Lack of Standardisation: Wide variation in PICC outcomes is tied to inconsistent technique, patient monitoring, and staff education.

Implications
While PICCs offer convenience and comfort, this review urges clinicians to reconsider their use—especially in critically ill or immunosuppressed patients. Thoughtful patient selection, use of ultrasound-guidance, proper site choice, and ongoing staff education are key to reducing harm. In some cases, a standard or tunnelled CVC may be safer.

Read More:https://www.mdpi.com/2227-9032/13/16/1993 

Authors: Benjamin Kalma, André van Zundert