Purpose: A PICC line is a Peripherally Inserted Central Catheter used to deliver medications, fluids and nutritional solutions into a central vein or the right atrium, as well as for blood sample draws. Cost, safety and convenience considerations currently favor PICCs over alternative venous access devices. Ultrasound guided placement techniques make it feasible to place catheters in veins that are as small as the catheters. However, this size parity might have its disadvantages, particularly if it results in stasis and potential thrombosis. The purpose of this prospective study is to assess the incidence of venous changes associated with upper extremity PICC line placement in pediatric patients.
Methods and Materials: 43 pediatric PICC line patients were included in the study. All the patients were scanned with ultrasound at the time of line placement 4 days to 335 days (median 44 days) after removal of the PICC. Patients ages ranged from 2 months to 17 years. The caliber and patency of the basilic, medial brachial, lateral brachial, cephalic, axillary and subclavian veins were assessed. Clinical, procedural and complication data were recorded.
Results: All veins that the PICC traversed were analyzed for the presence or absence of occlusion or stenosis. A stenosis was defined as greater than 33% reduction in the diameter of the vein. 68% of the patients had a new stenosis or occlusion in at least one vein by either the size criteria or the inability to demonstrate a vein that was seen patent on the pre-procedure ultrasound. 24% had thrombosis or occlusion of the entry vein at the time of follow up, as evidenced by partial or complete incompressibility of the vein. Only one of those patients had a clinically evident deep venous thrombosis. Vein abnormalities were more common if the patient was younger than 22 months, the ratio of PICC lumen diameter to entry vein diameter was greater than 0.4, or PICC stayed in the patient more than 38 days. However, they were also seen after short term use, and in patients without severe background illnesses.
Conclusion: PICC lines are associated with reduced vein patency in the majority of the veins through which they are placed. This seems to be somewhat related to the age of the patients, the ratio between the size of the PICC and the entrance vein and the duration of placement, though was also seen after short term use. This process is clinically silent, but its long term significance can be pronounced, especially in chronic patients, who are expected to return for several lines.