One in four peripherally inserted central catheters (PICCs) are used for five days or less when they should be reserved for long-term use, according to US researchers.
Their findings highlight the need for efforts to focus on reducing short-term use of PICCs and help clinicians consider other alternatives for short-term IV access that pose less risk, they said.
“When PICCs first came out, they became an ‘easy button’ for vascular access”
The study authors, from the University of Michigan, noted that over the past decade PICCs had become the “go-to device” for intravenous care.
But their new study found that one in every four times a PICC was inserted, the patient did not need it long enough to justify the risks that it could also pose.
For example, in the five days or less that patients had a PICC implanted, they found nearly one in 10 experienced a blocked line, an infection, a blood clot or another complication linked to the device.
In addition, one in three short-term PICC patients also had serious kidney problems that could make them potential dialysis candidates.
The study, published in the Journal of Hospital Medicine, was a large-scale examination of real-world use of PICCs and the factors associated with their short-term use.
It was based on data from 52 hospitals around the state of Michigan, which were involved in a major quality improvement and patient safety effort.
“This study helps illustrate how medical devices such as PICCs can be both helpful and harmful”
It involved analysis of records from 15,397 PICC placements over two-years from 2014 to 2016, before and after guidelines for safe and appropriate PICC use – known as MAGIC – were introduced.
The researchers found patients were more likely to receive a PICC for short-term use if they were considered to have “difficult vascular access”.
Clinicians may default to choosing a PICC in these patients in order to keep an intravenous access point open, rather than having to find a vein each time, noted the study authors.
Patients whose clinicians ordered a multi-lumen IV device, to avoid contact between different medications or nutrition solutions, were also more common among short-term PICCs.
Interestingly, the researchers noted that patients treated in teaching hospitals were more likely to receive a short-term PICC than those treated in non-teaching hospitals.
They highlighted that the body’s reaction to foreign material and the mechanical stress put on veins when a PICC was inserted, could combine to damage veins and increase the risk of clots or scarring.
The damage could keep a dialysis candidate from being able to successfully establish a vascular fistula, which would have been the preferred way to receive long-term dialysis, they warned.
In all, 9.6% of the short-term PICC patients experienced a complication, including 2.5% who experienced a blood clot forming in their vein and 0.4% who developed a central line associated blood stream infection.
Peripherally inserted central catheters
Lead author Dr David Paje said: “When PICCs first came out, they became an ‘easy button’ for vascular access, and the safety issues weren’t recognized. Now the dynamics have changed, and we need to be more thoughtful with their use.
“The use of PICCs exploded because the safety issues were not initially recognized, including those associated with clots and infections, noted Dr Paje.
“Now we’re coming back full circle, and we need to adapt and implement quality improvement processes to be more judicious with their use,” he said. “We need to recognize that PICCs are not without any consequence, even for short-term use.”
He highlighted that most of the reasons cited for PICC use in the study, such as delivering antibiotics, did not require the deep access to the central bloodstream that PICC provides.
He added that patients or their representatives “should be actively engaged, and informed” on decisions on IV devices. “Find out what lines they’re putting in, and ask questions,” he said.
Senior study author Dr Vineet Chopra said: “This study helps illustrate how medical devices such as PICCs can be both helpful and harmful.”