Choosing Wisely:

Don't place, or leave in place, peripherally inserted central catheters for patient or provider convenience.

Rationale and Comments: Peripherally inserted central catheters (PICCs) are commonly used devices in contemporary medical practice that are associated with two costly and potentially lethal health care-acquired complications: central-line associated bloodstream infection and venous thromboembolism. Given the clinical and economic consequences of these complications, placement of PICCs should be limited to acceptable indications (long-term intravenous antibiotics, total parenteral nutrition, chemotherapy and frequent blood draws). PICCs should be promptly removed when acceptable indications for their use ends.
Sponsoring Organizations:
  • Society of General Internal Medicine
  • Sources:
  • Systematic review and meta-analysis
  • Disciplines:
  • Surgical
  • Infectious disease
  • References: • Chopra V, Anand S, Krein SL, Chenoweth C, Saint S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med. 2012;125(8):733-74.
    • Chopra V, Anand S, Hickner A, Buist M, Rogers MA, Saint S, Flanders SA. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet. 2013 May 17; pii: S0140-6736(13)60592-9. ePub ahead of print.
    • Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest. 2005;128(2):489-95.
    • Tejedor SC, Tong D, Stein J, Payne C, Dressler D, Xue W, Steinberg JP. Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the "Idle central venous catheter". Infect Control Hosp Epidemiol. 2012 Jan;33(1):50-57.

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