PICC Related Infections
Infections related to any intravenous line can be local or spread to other parts of the body resulting in more serious consequences. Each year, according to research published in MMWR journal in 2006(1), an estimated number of 250,000 serious cases occur directly as a result of central venous catheter placements in the United States. Blood stream infections which follow have an estimated attributable mortality of 12%-25% for each infection.
The incidence of PICC related infections varies considerably according to the type of catheter, frequency of catheter change, sterile technique during insertion, subsequent care by health care providers as well as patient-related factors such as underlying disease and nature of illness. Although the incidence of local or bloodstream infections associated with PICCs are usually quite low compared to other central access, serious infectious complications produce considerable annual morbidity because of the frequency with which such catheters are used in all areas of healthcare practice.
Local infections range from simple staphylococcal infections at the insertion site to abscesses and deep cellulitis. The most serious cases result from mixed aerobic and anaerobic bacteria, with a breakdown of large amounts of tissue. It is far more common, however, for infection to spread along the veins, thrombophlebitis, or via the lymphatic vessels, lymphangitis. A main complication with thrombophlebitis occurs when clots developed in the infected vein spread to other veins in the arm, thus making further catheter placement more difficult.
Though treatment is typically instituted by the time infection spreads and the offending cannula is removed, small pieces of infected clots may break off and blood stream infection (septicemia) can result. Once out of control, usually in sick patients in critical care settings, organ failure can result in death. The other scenario is multiple abscesses which spread to other sites of the body, causing brain, liver and lung abscesses.
It has been shown that serious infective complications can be substantially higher in central subclavian or jugular placements compared to PICCs. Regardless, the PICC practitioner should be cautious and wary of developing complications and take appropriate steps to control it as early as possible. As previously stated, technique plays an extremely important role, and proper sterile technique and hygienic practices after insertion can greatly reduced infection rates.
References
(1) Reduction in central line-associated bloodstream infections among patient in intensive care units - Pennsylvania, April 2001-March 2005. MMWR 2005; 54: 1013-1016
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