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      Peripherally inserted central catheters in critically ill patients – complications and its prevention: A review

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          Abstract

          Peripherally inserted central catheter (PICC) is extensively used in critical care settings, because it plays a vital role in providing safe central venous entry. However, PICC is associated with several complications, which should be detected to shorten the duration of patients’ improvement, reduce health care cost, and lessen the incidence of various PICC-related complications. Therefore, this study aimed to outline current literature on PICC procedures, potential complications, and measures for prevention. Understanding evidence-based guidelines regarding insertion technique, early detection of complications, and care bundle of PICC is significant in complication prevention. Implementation of education, training, and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications. Thus, the strict care of indwelling PICC lines, the targeted and reasonable PICC-associated complication prevention, and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.

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          Most cited references69

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          Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections.

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            Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence.

            The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization, PICCs have eliminated the need for such practice. However, PICCs may not be as innocuous as once thought; a growing body of evidence suggests that these devices also have important risks. This review discusses the origin of PICCs and highlights reasons behind their rapid adoption in medical practice. We evaluate the evidence behind 2 important PICC-related complications--venous thrombosis and bloodstream infections--and describe how initial studies may have led to a false sense of security with respect to these outcomes. In this context, we introduce a conceptual model to understand the risk of PICC-related complications and guide the use of these devices. Through this model, we outline recommendations that clinicians may use to prevent PICC-related adverse events. We conclude by highlighting important knowledge gaps and identifying avenues for future research in this area.
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              Risk of symptomatic DVT associated with peripherally inserted central catheters.

              Previous studies undertaken to identify risk factors for peripherally inserted central catheter (PICC)-associated DVT have yielded conflicting results. PICC insertion teams and other health-care providers need to understand the risk factors so that they can develop methods to prevent DVT.
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                Author and article information

                Contributors
                Journal
                Int J Nurs Sci
                Int J Nurs Sci
                International Journal of Nursing Sciences
                Chinese Nursing Association
                2352-0132
                21 December 2018
                10 January 2019
                21 December 2018
                : 6
                : 1
                : 99-105
                Affiliations
                [a ]School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
                [b ]Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
                Author notes
                []Corresponding author. qh20063@ 123456163.com
                Article
                S2352-0132(17)30129-1
                10.1016/j.ijnss.2018.12.007
                6608659
                31406874
                aef52b42-932b-439c-8dfe-94a1a1b9eef7
                © 2019 Chinese Nursing Association. Production and hosting by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 25 April 2017
                : 6 December 2018
                : 20 December 2018
                Categories
                Review

                catheterization,central venous,complications,intensive care,patients,prevention strategies,review

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