title: Peripherally inserted central catheter (PICC) complications during pregnancy.
abstract: BACKGROUND
  Peripherally inserted central catheters (PICCs) are routinely used in women with hyperemesis gravidarum. However, little is known about the consequences of PICC insertion in these patients. Our aim was to analyze PICC-related complication rates among pregnant women.
  
  
  METHODS
  Pregnant women with PICC insertion between January 2000 and June 2006 were studied retrospectively. Infusate type, comorbid conditions, and PICC duration were characterized. Major complications, defined as need for surgical intervention, bacteremia requiring intravenous antibiotics, or thromboembolic events, were identified. Minor complications, including phlebitis, PICC malfunction, early PICC removal, infection requiring oral antibiotics, or hospitalization for PICC evaluation, were also studied.
  
  
  RESULTS
  Eighty-four catheters in 66 women were eligible for study, totaling 2544 PICC days. Catheters remained in place for 1-177 days; median duration was 21.0 days. PICCs were used for intravenous fluid (IVF, 59.4%), parenteral nutrition (PN, 34.5%), and antibiotics (6%). The overall complication rate was 18.5 per 1000 PICC days (55.9% of PICCs); 22.6% were major, with bacteremia being most frequent (20.2%). A diagnosis of diabetes was the only factor that significantly predicted complications (hazard ratio, 2.71; 95% confidence interval, 1.13-6.13). PICC duration and type of infusate (PN vs IVF alone) were not associated with complications.
  
  
  CONCLUSIONS
  PICC insertion in pregnant women is associated with a high complication rate, which appears to be independent of the type of infusate and occurs in the majority of women. PICCs should be used judiciously and only when clearly necessary during pregnancy. Further studies are needed to determine how to reduce PICC-related complications in this population.
authors.affiliation: Mount Kisco Medical Group, Mount Kisco, New York acape@mkmg.com.
authors.forename: Alison V
authors.initials: AV
authors.lastname: Cape
authors.affiliation: Department of Nutrition.
authors.forename: Kris M
authors.initials: KM
authors.lastname: Mogensen
authors.affiliation: Department of Surgery.
authors.forename: Malcolm K
authors.initials: MK
authors.lastname: Robinson
authors.affiliation: Department of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Daniela A
authors.initials: DA
authors.lastname: Carusi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D010689:Phlebitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: complication; infection; peripherally inserted central catheter; pregnancy; thrombosis