Table S2. Definitions, diagnosis, ant treatment of PICC-related complications (see references below )
Complications
Inmediate
complications
(first 24 h)
Late major
complications
Late minor
complications
Definitions/evaluation
Diagnosis
Treatment
Mechanical
complications
Arterial
puncture,
pneumothorax,
mediastinal haematoma, haemothorax.
Radiography
evaluation.
Malposition
PICC requiring
reinsertion.
Radiography.
Reposition the PICC tip.
Bloodstream
infection
Bacteriemia or fungemia in patients
with intravascular device and > 1
positive blood cultures obtained from
the peripheral vein, clinical
manifestations of, and no apparent
source for bloodstream infection.*
Blood cultures obtained from
PICCs and peripheral blood.
Empirical antimicrobial therapy.
Modify according to results of the
blood cultures. Consider PICC
removal.
Symptomatic
PICC-related
thrombosis
Limb pain or swelling.
Doppler ultrasound. **
Anticoagulant therapy. Consider
PICC removal.
Phlebitis
Signs/symptoms of inflammation along
a superficial vein.
Physical examination.
Extremity elevation, warm or cool
compresses and topical diclofenac
emulsion gel (associated or not to
oral diclofenac 75 mg bid).
Exit-site
infection
Signs/symptoms of inflammation within
2 cm of the PICC exit site.
Concomitant blood and exitsite cultures.
Topical antibiotic agents. PICC is
left in place. If ineffective,
administrate systemic antimicrobial
therapy.
Catheter
occlusion
Inability to flush, to infuse, and/or to
aspirate from the catheter requiring the
use of Urokinase to restore the patency
of the PICC, at least once, during the
period of time that the PICC was in
place.
Linogram, if Urokinase is
ineffective.
Thrombolytic therapy. ***
Mechanical
disfunction
Inability to infuse through PICC due to
tight suture, catheter tip positioned
against vessel wall, precipitation of
infused drugs or lipid residues.
Evaluate Huber needle
placement. Radiography if
pinch-off syndrome is
suspected. Review medications
and parenteral nutrition
preparations.
Reposition the patient. Drug
precipitate or lipid: cause-specific
therapy. ****
Mechanical
obstruction
Inability to flush, to infuse, and to
aspirate through PICC due to kinking or
dislodgement of catheters.
Radiography and/or Linogram,
Consider PICC removal,
readjustment
or
and
clinical
Blood transfusion or
Consider PICC removal.
*One of the following should be present: a positive result of semiquantitative or quantitative catheter culture, where by the
same organism is isolated from a catheter segment and a peripheral blood culture; simultaneous quantitative cultures of
blood with a ratio of >3:1 CFU/mL of blood (catheter vs. peripheral blood); or differential time to positivity.
**Thrombosis of the subclavian, axillary, humeral, basilic and cephalic veins were included. ***Urokinase 10.000 units
(Abbokinase Open-Cath; Abbott Pharmaceuticals, Abbot, IL). After 15 min, the solution will be aspirated for checking the
catheter patency. If first attempt is ineffective (for total of 2 doses),leave second attempt of Urokinase indwelling up to 24
hours before proceeding with next steps in troubleshooting. **** Should be treated with sodium bicarbonate (1·0 mol/L) or
sodium hydroxide (0·1 mol/L).
References
surgery.
1.
Worth LJ, Seymour JF, Slavin MA (2009) Infective and thrombotic complications of
central venous catheters in patients with hematological malignancy: prospective
evaluation of nontunneled devices. Support Care Cancer 17:811–818.
2.
Harter C, Ostendorf T, Bach A, Egerer G, Goldschmidt H, Ho AD (2003) Peripherally
inserted central venous catheters for autologous blood progenitor cell transplantation in
patients with haematological malignancies. Support Care Cancer 11:790–794
3.
Leonard A. Mermel, Michael Allon, Emilio Bouza, Donald E. Craven, Patricia Flynn,
Naomi P. O’Grady, Issam I. Raad, Bart J. A. Rijnders, Robert J. Sherertz, and David K.
Warren, (2009). Clinical Practice Guidelines for the Diagnosis and Management of
Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society
of America. Clin Infect Dis. 49(1): 1–45. doi: 10.1086/599376.
4.
O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H,
McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. (2002)
Guidelines for the prevention of intravascular catheter-related infections. Am J Infect
Control 30(8):476–489.