IS Case 94: Common PICC Complication: Upper Extremity Thrombosis

Nate Johnson, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-20

History

A 12-year-old male with history of chronic granulomatous disease developed acute onset of swelling involving arm where peripherally inserted central catheter (PICC) had placed 1 month prior for total parenteral nutrition (TPN).

Diagnosis

Common PICC complication: upper extremity thrombosis

Discussion

PICC line placement is associated with several complications that patients and providers must be aware of before placing the PICC. These include:

  1. Immediate issues such as bleeding, arrhythmias, arterial puncture, and placement failure that occur in up to 5% of patients.
  2. Post-insertion phlebitis complicates up to 13% of patients in the first 72 hours post-procedure.
  3. Central line infection is judged based on number of catheter days and estimates include one-half to one patient per 1000 days that a catheter is in place.
  4. Thrombosis of the upper extremity veins seen in 2.4-5% of patients.
  5. Rarer complications such as breakage of the catheter can be seen in 0.1% of patients.

In the Cleveland Clinic's retrospective study [1] of 2063 patients status post PICC placement, they found that 2.4% of PICCs patients developed thrombosis. Only half of these extended into the innominate, subclavian or internal jugular with the rest remaining in the smaller peripheral vessels. Pulmonary embolism complicated one of the patients in the study.

References

  1. Chemaly RF, de Parres JB, Rehm SJ, et al. Venous thrombosis associated with peripherally inserted central catheters: a retrospective analysis of the Cleveland Clinic experience. Clin Infect Dis. 2002 May 1;34(9):1179-83. [PMID: 11941543]
  2. Kandarpa K, Aruny J. Peripherally Inserted Central Catheters and Arm Ports, IN: Handbook of Interventional Radiology. Lippincott Williams & Wilkins, Philadelphia, PA, 2001.

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