PICCs and CLABSIs

Q: Peripherally Inserted Central Catheters (PICCs) are a viable option to decrease Central Line-Associated Bloodstream Infections (CLABSIs).

A) True

B) False

Answer: B

Unfortunately, in recent years PICCs have been promoted as a viable option to replace Internal Jugular (IJ), Subclavian (SC), and femoral central lines on the pretext of decreasing infections and risk of thrombosis. Although it is true that PICCs may decrease injury to the vessels and pneumothorax, they actually carry a higher risk of thrombosis(odds ratio 2.55). This risk is even higher in ICU and in patients with malignancy. They are also not recommended to be used as a strategy to reduce bloodstream CLABSIs.

Also, PICCs (as well as SC-central lines) should be ideally avoided in patients with GFR less than 45 mL/minute.

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References:

1. Chopra V, Anand S, Krein SL, et al. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 2012; 125:733.

2. Yokoe DS, Anderson DJ, Berenholtz SM, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol 2014; 35 Suppl 2:S21.

3. Bhutani G, El Ters M, Kremers WK, et al. Evaluating safety of tunneled small bore central venous catheters in chronic kidney disease population: A quality improvement initiative. Hemodial Int 2017; 21:284.