Complications

PICC lines have demonstrated a lower incidence of complication than other types of central venous catheters. However, insertion of any indwelling catheter entails some risk. Nurses should remain vigilant for the following complications.

• Leakage at the site may occur. This may be caused by loss of elasticity of the skin around the insertion site, outward migration of the catheter, or rupture of the catheter.
• Catheter related blood stream infections (CRBSI) associated with PICC devices vary by setting. The rate of CRBSI in high-risk hospitalized patients with PICCs is about 2-5 per 1000 patient days. CRBSI in outpatient PICCs occur about 0.4 per 1000 patient days. (Safdar, N.; Maki, G. 2005) Improvements in PICC management may further reduce the incidence of CRBSI.
• Phlebitis at the site is another complication that could occur and can be classified as mechanical, bacterial or chemical (Mazzola, Schott-Baer, & Addy, 1999).
  • Mechanical phlebitis is sometimes noted 24 to 72 hours after insertion and usually subsides with the application of moist heat (Rice, 1992).
• Chemical phlebitis can occur but it is not common with PICC lines because the tip of the catheter lies in large vessels, which provide adequate dilution of medications.
• Thrombosis may occur due to infection, catheter malposition and chemical precipitates. Signs and symptoms of thrombosis include swelling of the arm or neck or pain on the same side as the catheter as well as increased arm circumference (Gorski & Czaplewski, 2005). Interventions include the delivery of thrombolytics within the catheter or the POP technique to eliminate the clot (Fetzer & Manning, 2004).
• Catheter migration may occur. A sign of catheter migration is an increase in catheter length at the insertion site or an inability to withdraw blood from the catheter. If you suspect catheter migration, a chest x ray is needed to confirm placement.
• Rare complications include emboli, damage to the intima and catheter breakage past the insertion point (Masoorli & Angeles, 1990, Brown, 1993).

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