Peripherally inserted central catheters in critically ill patients - complications and its prevention: A review.
Sona Duwadi, Qinghua Zhao, Birendra Singh Budal
PMID 31406874WHAT IT FOUND
Nurses and caregivers managing PICC lines in critically ill patients can reduce infection and thrombosis risks by using ultrasound guidance, 2% chlorhexidine for skin antisepsis, and confirming tip position via chest X-ray.
Selecting the smallest appropriate catheter and maintaining strict aseptic technique during dressing changes are also key preventive measures.
Key findings
01Ultrasound-guided insertion and confirming catheter tip position in the distal superior vena cava via chest X-ray significantly reduce the incidence of upper extremity deep vein thrombosis.
02Using 2% chlorhexidine gluconate for skin antisepsis results in lower rates of catheter-related infection compared to povidone-iodine or alcohol.
03Smaller catheter diameters (e.g., 4F) are associated with lower thrombosis rates compared to larger diameters (e.g., 6F), and normal saline flushing is preferred over manual heparin preparation to reduce contamination risks.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review, so the selection of studies may be subject to bias. The review includes data from studies with varying designs and patient populations, leading to wide ranges in reported complication rates. The authors note that scientific evidence on specific preventive measures is limited and that well-designed prospective trials are needed. The review does not distinguish between different age groups among critically ill patients.
Declared interests
The text does not explicitly state funding sources or conflicts of interest for the authors of this review.
The easy way to misread this
Do not assume that any single intervention guarantees the elimination of complications; the review highlights that complication rates vary widely across studies and that multiple factors, including patient status, catheter type, insertion technique, and maintenance care, interact to influence outcomes.