The Peripherally Inserted Central Catheter (PICC): A Prospective Study of its Natural History after Cubital Fossa Insertion

Abstract

A prospective cohort study was undertaken to describe the natural history of the cubital fossa peripherally inserted central catheter (PICC), determine which factors influenced the hazard of complication and develop a standard methodology for evaluation of a PICC service. A total of 4349 patient days of PICC observation were analysed using survival analysis techniques. The median time to PICC removal for a complication was 60 days. The most common complications were phlebitis, malposition and tip migration. Complications usually occurred during the first week. There was only one episode of line-related sepsis. Size 3 French gauge catheters had a complication rate of 7.3 per 1000 line days compared to 14.2 for 4 French catheters (hazard rate 1.26 90% CI 1.02 to 1.55). PICCs requiring two or more attempts at insertion were more likely to develop complications than those inserted at the first attempt: 20 per 1000 line days vs 10.5 but the confidence intervals were wide (hazard rate 1.91, 90% CI 0.90 to 4.05). Operator (amongst the four experienced operators who inserted all PICCs), arm of placement, or medial or lateral placement in the cubital fossa did not influence PICC survival.

A comprehensive intervention program on the long-term placement of peripherally inserted central venous catheters

“…Unfortunately, the duration is not long enough in previous studies. In this paper, we performed four courses of chemotherapy with the duration of at least 90 days, comparing favorably with previously published reports of 19.5 [13] , 40, [14] and 60 [15] days for inpatient. A comprehensive intervention for nursing care to reduce complications in the therapy was started at the beginning of catheterization and lasted the whole process of catheter insertion and maintenance.…”

Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring

“…PICC insertion can be complicated by the inability to advance the wire or catheter past venous valves and malposition of the catheter outside of the desired superior vena cava to right atrial junction [21]. Catheters not in adequate position should not be used for hemodynamic monitoring.…”

Safety and Effectiveness of Central Venous Catheterization in Patients with Cancer: Prospective Observational Study

“…The PICCs were inserted mid-arm with USG in both hospitalized patients and outpatients in our study. The mid-arm insertion site may have resulted in tip migration with arm motion; therefore, PICCs should be fixed well and patients, especially outpatients, need to be educated (26, 27). …”