Literature Review

This literature review includes practice guidelines and selected articles that focus on the safe management and utilization of peripherally inserted central catheters (PICC). Topics include: Central line-associated blood stream infections (CLABSI), risks and benefits associated with PICC use, the nursing role in PICC utilization.

CDC - 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections this evidence based document is intended for health care professionals who insert or manage intravascular catheters in a variety of setting. Topics include:

CDC - Morbidity and Mortality Weekly Report - Vital Signs: Central Line--Associated Blood Stream Infections --- United States, 2001, 2008, and 2009.

Patient-Reported Usefulness of Peripherally Inserted Central Venous Catheters in Terminally Ill Cancer Patients

Peripherally inserted central venous catheters in the acute care setting: A safe alternative to high-risk short-term central venous catheters.

Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients

Peripherally Inserted Central Venous Catheters and Central Venous Catheters in Burn Patients: A Comparative Review

Yamamoto, Alvin J, et al., 2002
The purpose of this comparative study was to determine the difference in complication rate between groups of patients who had PICC lines sutured in place, compared to those using the "StatLock" device. One hundred seventy patients with either suture or "StatLock" securement were randomly selected and screened for complications. Although the differences between groups was not statistically significant, the results were interesting. The "StatLock" device was less time-consuming to use and this group had fewer total complications, compared to the suture securement method group.

Cowl CT, et al., 2001
Complication rates for patients receiving TPN through subclavian central lines and through PICC lines were compared, in order to determine the cost effectiveness of using PICC lines for TPN. One hundred two patients were included in the study and the results showed a 67% complication-free rate for subclavian lines and a 47% complication-free rate for PICC lines. PICC lines were associated with a higher incidence of thrombophelibitis in this study. The researchers concluded that, although it was once thought the PICC lines were more cost-effective for TPN delivery, this may not be true in all cases.

Mazzola, Schott-Baer, & Addy, 1999
This comparative study explored the differences in coagulation status, immune status, insertion-related differences and nutritional status between hospitalized adults who developed phlebitis after PICC insertion and those who did not develop phlebitis. They found that there was a lower incidence of phlebitis in patients who had higher platelet levels. A higher incidence of phlebitis was reported in patients who had a four french catheter placed over those who had a three french catheter placed. They also found that catheter manipulation during insertion was also associated with a higher incidence of phlebitis.

Thiagarajan, R. R. et al., 1998
Conducted a cohort study of noncentral vein placement PICC-type catheters (midlines) in children. The purpose was to describe the efficacy of this type of placement. The researchers found that centrally placed PICC lines had a longer dwelling time than midline catheters, however the treatment completion rates were similar. Catheter complication rates were also similar between the central and midline catheters. Although the infusate was not mentioned in the article, the researchers concluded that noncentrally placed PICCs, with a dwell time of 2 weeks, were a safe alternative to centrally placed catheters in children.

Smith, J. R., et al., 1998
This retrospective study was a comparison of percutaneous central venous catheters and PICC lines. The researchers found that the PICC lines had a higher complication rate, which included an increase in catheter malfunction and arm phlebitis. The study also found that central venous catheters were 5 times more costly than PICC lines. The researchers concluded that PICC lines were safe and cost effective for two or three weeks of treatment. It was recommended that a percutaneous central venous catheter be used for longer treatment times.

Woods & Bowe-Geddes, 1997
This retrospective study explored two different types of PICC line and midline securement techniques used in the homecare setting. The first technique involved securing the catheter with steri-strips and tape and then covering with a transparent dressing. The second technique utilized a "StatLock" system which consisted of an adhesive anchor pad and luer lock extension covered with a transparent dressing. The results of this study, based on 1000 catheter days, demonstrated that the "StatLock" system had fewer complications, catheter dislodgements and unscheduled nursing visits.

Ng, P. K., et al., 1996
This study reported PICC line complication, success, and insertion complication rates in an intensive care unit. Ninety-one PICC lines were studied. The researchers found that 97.8% of the placements were successful. Some of the complications encountered were malposition, catheter clotting, bleeding, mechanical phlebitis, and arterial puncture. IV therapy completion was successful in 74.7% of patients. The most frequent causes of failure to complete the therapy were catheter dislodgement and infection. The researchers concluded that the initial success rates warranted further study of PICC lines in the intensive care setting.