title: Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence.
abstract: 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.
authors: Division of General Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA. vineetc@umich.edu
authors: Vineet
authors: V
authors: Chopra
authors: Sarah
authors: S
authors: Anand
authors: Sarah L
authors: SL
authors: Krein
authors: Carol
authors: C
authors: Chenoweth
authors: Sanjay
authors: S
authors: Saint
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000209:etiology* / Q000517:prevention & control; D001800:Blood Specimen Collection; D001803:Blood Transfusion; D055499:Catheter-Related Infections / Q000209:etiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D012307:Risk Factors; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents