Risks of PICC Lines
Peripherally inserted central catheters provide prolonged venous access, a means of administrating medications that would otherwise be irritating to smaller peripheral blood vessels and a method of insuring nutrition via a venous route to patients unable to tolerate oral feedings. Not only do these central lines provide life-saving therapy, they are easily inserted, cost effective and convenient.
There are, indeed, many benefits in using these catheters. However, physicians, nurses and patients must be aware of the risks involved with placement of PICC lines so that complications can be minimized. Although the risks of PICC lines are low, and the lowest of all centrally placed IV access devises, there are several serious complications which can occur.
Following are some of the complications that can associated with PICC lines:
- Air Embolism: Air bubbles may enter the blood vessel during insertion of a PICC. This may produce symptoms such as decreased blood pressure; lightheadedness; confusion; increased heart rate; anxiety; chest pain; or shortness of breath.
- Infection: It is possible for an infection to develop either inside the vessel or surrounding the insertion site where the catheter enters the vein. The symptoms include fever; chills; tachycardia; fatigue; muscle aches; weakness; decreased blood pressure; redness, swelling or purulent drainage at site; or elevated white blood cell count.
- Phlebitis: This is inflammation of the vein where the catheter is inserted. The symptoms include redness; pain at access site; streak formation; palpable venous cord; or purulent drainage.
- Catheter Malposition: Malposition can occur during PICC insertion or later due to changes in pressure inside the chest or from catheter migration. After the insertion of catheter, the position of its tip is confirmed via x-ray. Confirmation of proper tip placement is required before using the device as a malpositioned catheter can cause serious complications. Securing the PICC catheter is also essential to help prevent catheter dislodgment or migration. Sutures should not be used to secure the catheter to the site as these can lead to complications such as infection at the site or catheter-related bloodstream infections.
- Thrombus Formation: Any catheter inserted into the vascular system increases the risk of thrombus formation, either in the vessel or in the catheter.
- Difficult Removal: There may be resistance when removing the catheter and this may occur at any time during the process.
- Nerve Injury or Irritation: During insertion of the catheter, nearby nerves may get injured or irritated producing symptoms such as a shooting type of pain down the arm; numbness; tingling; pins and needles effect; weakness of extremity; or paralysis.
- Leakage: Occasionally leakage at the insertion site may occur. This may be caused by loss of elasticity of the skin at the site, outward migration of the catheter, or rupture of the catheter.
- Catheter Breakage: Rarely, catheter damage can occur and most often it is from improper care. It may occur due to improper anchoring, using a syringe that is less than 10ml, or from applying excessive pressure when flushing the device. If the catheter is placed in the elbow bend, breakage can also occur from repetitive motion, which should be avoided.
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