Peripherally inserted central catheters: a walk down memory lane ...

Abstract

Central venous catheters (CVCs) are essential in the treatment of critically ill patients. For skilled intensive care unit (ICU) physicians, insertion of these catheters in large central veins is routine practice. Peripherally inserted central catheters (PICCs) were used in the early phase of intensive care as a surrogate for centrally inserted lines by less experienced physicians and in some departments (for example, hematology) with very specifi c patient categories. With the development of the ICU, peripherally inserted lines have been abandoned for more than two decades, at least in our center. Many bleeding and more serious local complications occurred. In more skilled hands, these lines were also not very popular, because of spasm of the vein, a tendency to take the wrong route (to the head), and thrombosis of the vein in up to 8% of patients [1]. In a study in the previous issue of Critical Care, Pittiruti and colleagues [2] evaluated 89 patients in whom ultrasound-guided insertion of multi-lumen CVCs in the deep veins of the upper mid arm (PICC) was performed. Besides 13 minor complications at insertion and two cases of sympto matic thrombosis (however, not routinely screened for), few complications occurred, and the authors conclude that PICC can be successfully used in most ICU patients. Before we advocate its routine use in the ICU, we need more and better studies. PICCs cannot compare with the historical experience with centrally inserted central catheters (CICCs). Skilled personnel, routine use of ultrasound, and insertion bundles have lowered the incidence of complications of CICCs. We would advocate a head-to-head comparison before we introduce PICC as more than a last resort.