PICC Line Complications: Why More Care Is Not Always Better.
I have a patient that comes in every so often that demands a peripherally inserted central line (PICC) line on admission. PICC line complications are common and frustrating, even though they are convenient for patients, nurses and doctors. They can be used to obtain blood without needing to stick the patient on a daily basis and PICC lines can be kept in for weeks or months with proper care using protectors and covers.
When old ladies and drug addicts present with poor veins, PICC lines can maintain safe and adequate IV access should these patients experience acute decompensation or critical illness during their hospitalization. However, these central lines can come with their own complications. I have had my share of patients return to the hospital with sepsis and shock from their PICC line, including endocarditis complications. Nephrologists hate them because the veins around the catheter often clot leading to fewer choices for arteriovenous fistulas in end stage renal failure. They can also cause upper extremity deep venous thrombosis which may require treatment with long term anticoagulants and potential complications from that therapy as well.
Some patients ask for PICC lines by name as a matter of convenience. They say they have terrible veins and some patients will even go so far as to demand a PICC line on admission before allowing any nurse or lab technician to draw blood. But PICC lines are not benign. These deadly complications can occur with relative frequency. Less commonly, PICC lines can fracture or have problems leaking at the site of entrance. With proper technique, PICC nurses can safely avoid arteries and nerves in the antecubital area of insertion, although these are also potential complicating issues as well.
More care is not always better care. In fact, some specialty societies are even recommending PICC lines not be placed if the patient's expected hospital stay is less than 48 hours. This picture here sent to me by a reader is an example of a less common complication of PICC lines. What you see is the tip of a PICC line after insertion that has looped up and knotted on itself. I have never seen this before. Normally the line can simply be pulled out of the body with a quick tug. In this case, it required a surgical cut down of the axillary vein. In a constant desire to make our lives simpler, often the risks can outweigh the benefits.