July 1, 2011 | Aging Services Risk, Quality, & Safety Guidance
Peripherally inserted central catheters (PICCs or PICC lines) are a type of central venous access device (VAD). They can be used in patient or resident populations to provide intravenous access for many therapies. PICCs are commonly used in long-term care, skilled nursing settings, and home care settings, as well as acute care and ambulatory care settings. PICC lines offer several advantages. For example, PICCs are generally less likely to become a site of infection than are other vascular access devices, and the use of proper sterile technique and barriers can decrease the risk of infection further (Moureau “Reducing the Cost”). Generally, they are a safer, less complicated alternative to central venous catheters (CVCs) (Akers and Chelluri; Al Raiy et al.; Gunst et al.).
PICCs are made of polyurethane or silicone rubber (Gabriel). PICCs, which are generally at least 20 cm long, are inserted into the basilic, cephalic, or brachial vein and ideally end in the distal superior vena cava. They have a lower rate of infection than nontunneled central vascular catheters. (CDC) PICCs come with one, two, or three lumens and should be used when therapy of more than five days is required (Gabriel). The most common complications of PICCs are infection, thrombosis, and occlusion, although newer antimicrobial- and antibiotic-impregnated PICC lines can help reduce the risk of infection (Hill et al.).
However, the risk of serious complications is lower with PICCs than other central venous catheters. One study found that only about 5% of acute care facility patients with PICCs will develop thromboembolism or related complications (Lobo et al.). Another study found that the use of PICCs instead of other central catheters was associated with reduced risk of infection and reduced use of antibiotics. The researchers suggest that if PICCs themselves are included as a part of central-line infection prevention initiatives, nearly 6,000 lives and $1.1 billion might be saved annually (Patel et al.).
Nevertheless, there are risks that must be managed regarding PICC line use. Incidents of infection, occlusion, thrombosis, and other events have led to resident harm. This Risk Analysis presents strategies for managing...