Patterns and predictors of peripherally inserted central catheter occlusion: the 3P-O study (2023)

section excerpt

Study environment and participants.

The present study used data from a collaborative clinical quality initiative supported by Blue Cross Blue Shield and Blue Care Network, which focuses on the prevention of adverse events in hospitalized patients. The design and setting of this consortium have been previously described. 10, 11 Since December 2013, 51 hospitals have participated in a prospective cohort study to investigate the use and outcomes of PICC. Adult patients admitted to a general medicine ward or intensive care unit (ICU) who received a PICC


A total of 14,278 PICCs placed in 13,408 patients during 307,320 catheter days were available for analysis. Regarding the characteristics of the PICCs (Table 1), 7,222 PICCs (50.6%) were double-lumen catheters, 4,965 (34.8%) were single-lumen catheters, and 2,091 (14.6%) were triple lumen (or larger). Most of the PICCs (n=13,000; 91.1%) were able to deliver current. Nurses with access to the vessel inserted most of the equipment (n= 10,525; 73.7%), followed by intervention


Data from this study of 14,278 PICCs suggest that occlusion affects up to 12% of PICCs and is associated with significant costs. Screening for putative risk factors shows that obese, diabetic, and critically ill patients experienced higher odds of occlusion than others. In contrast, PICC placement in the right arm was associated with lower occlusion rates than placement in the left arm, possibly due to the shorter length of the catheter when placed in this extremity. The presence of catheters.

Quoted by (33)

  • Midline catheters: a 3-year experience at a Veterans Administration medical center

    2023, American Journal of Infection Control


    VTE was defined as symptomatic deep vein thrombosis (DVT) in either extremity or symptomatic pulmonary embolism (PE) not present at catheter insertion and confirmed by imaging (ultrasound or venogram for DVT; computed tomography or ventilation-perfusion). for PE). Minor catheter complications were defined according to previously published definitions.15,16 Patients were followed up until the time of catheter removal or death, whichever occurred first.

    Midline catheters are recommended over peripherally inserted central catheters as a short-term vascular access device for peripherally compatible infusions. We evaluated the efficacy and safety of midline catheters.

    Data on midline catheter placements from June 2016 to May 2019 at a Veterans Administration tertiary medical center were collected retrospectively. Patients were followed until catheter removal or death, whichever came first. The primary outcome was completion of planned treatment; secondary outcomes were catheter-related complications, including major events (eg, catheter-related bloodstream infections [CRBSI] or venous thromboembolism [VTE]) and minor events (eg, catheter occlusion, kinks, displacement).

    Of 115 central lines, 62 (53.9%) were for antibiotic infusion and 49 (32.6%) were difficult to access. The mean stay was 11 days (interquartile range, 5.5-19.5 days). Midline catheters lasted until completion of therapy in 93 patients (80.9%). Catheter-related complications occurred in 27 patients (23.5%), including catheter dislodgment in 10 patients (8.7%), catheter breakage in 8 (7.0%), and catheter occlusion in 3 (2.6%). Only 1 patient experienced a major complication, deep vein thrombosis (0.9%).

    Central lines appear to be effective and safe for short-term vascular access in patients requiring peripherally compatible infusions. Although the major complication rate is low, minor complications requiring device removal are common.

  • Comment on: Use of Peripherally Inserted Central Catheters (PICCs) in ICU Patients

    2021, Critical Care Journal

  • Risk of venous thromboembolism after peripherally inserted central catheter replacement: analysis of 23,000 hospitalized patients

    2018, American Journal of Medicine


    Alternatively, newer technology such as subcutaneous anchor devices may help avoid replacement.26,27 Similarly, it is important to prevent catheter occlusion through careful attention to irrigation and better device selection. (increased use of single-lumen devices).28 Note that this is important. to emphasize that occlusion itself does not necessarily indicate thrombosis, as occlusion more often represents intraluminal clots, drug precipitation, or fibrin sheath around the catheter tip than deep vein thrombosis.29

    Catheter exchange through a guidewire is often performed due to malfunction of peripherally inserted central catheters (PICCs). It is not known whether such exchanges are associated with venous thromboembolism.

    We conducted a retrospective cohort study to assess the association between PICC exchange and the risk of thromboembolism. Hospitalized adult patients who received a PICC during clinical care at one of 51 hospitals participating in the Michigan Hospital Medicine Safety Consortium were included. The primary outcome was the risk of symptomatic venous thromboembolism (radiographically confirmed upper extremity deep vein thrombosis and pulmonary embolism) in those who underwent PICC replacement versus those who did not.

    Of 23,010 patients who underwent PICC insertion in the study, 589 patients (2.6%) experienced a PICC switch. Nearly half of all exchanges were performed due to catheter dislodgement or occlusion. A total of 480 patients (2.1%) experienced deep vein thrombosis associated with PICC. The deep vein thrombosis rate was higher in those who underwent PICC replacement compared with those who did not (3.6% vs. 2.0%,PAG<.001). The median time to thrombosis was shorter among those who underwent replacement compared with those who did not (5 vs 11 days,PAG=.02). After adjustment, PICC exchange was independently associated with a 2-fold increased risk of thrombosis (hazard ratio [HR] 1.98; 95% confidence interval [CI], 1.37–2.85 ) versus no exchange. The effect size of PICC exchange on thrombosis was second in magnitude to device lumen (HR2.06; 95% CI, 1.59-2.66 and HR2.31; 95% CI, 1.6-3.33 for dual- and triple lumen) .

    PICC guidewire switching may be associated with an increased risk of thrombosis. As some exchanges can be prevented, it is necessary to consider the risks and benefits of exchange in clinical practice.

See all the articles that cite in Scopus

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What is occlusion of peripherally inserted central catheter PICC line? ›


Catheter occlusion is defined as a temporary or permanent inability to aspirate blood or infuse therapeutics through a lumen of a vascular access device.

What causes occlusion in PICC line? ›

Catheter occlusion can occur as a result thrombotic and non-thrombotic causes. A blood clot is the most common cause of catheter occlusions. Thrombosis can occur in any one of the veins catheterized (including the SVC) or the catheter itself.

What is the most common complication of PICC line? ›

Infection and thrombosis are the two most common complications. Along with education and training, adoption of a central line bundle of safety practices is recommended to reduce the risk of infection associated with PICC placement.

How do I manage a blocked PICC line? ›

To care for your PICC line, you will need to flush it. This means you'll need to clean it with a solution as directed by your healthcare provider. This keeps it from getting clogged or blocked. A clogged or blocked PICC line will need to be taken out and replaced.

What to do if central line is occluded? ›

Try flushing the catheter with 10ml 0.9% saline. If the fluids still refuse to free-flow, then instil Urokinase into the catheter and leave for 60 minutes. If this fails, repeat the Urokinase instillation but this time leave it in the line for several hours or overnight.

How serious is a clogged PICC line? ›


Such obstruction can have serious consequences on the patient: the catheter can become unusable, thus delaying treatment and, in the worst case, making its removal and/or replacement necessary.

What is the most common cause of catheter occlusion? ›

Because thrombosis is the most common cause of catheter occlusion, initial treatment is directed at dissolving clot.

Is a clogged PICC line an emergency? ›

If you don't care for your PICC line properly, you could develop complications such as occlusions (blockage), phlebitis (inflammation of a vein), thrombosis (blood clots), hemorrhage (bleeding), and infection. Call your healthcare provider or go the emergency department immediately, if: You develop a fever.

What are the symptoms of a blood clot with a PICC line? ›

Blood clots
  • swelling, redness or tenderness in the arm, chest area or up into the neck (on the same side as the PICC line)
  • a swollen hand (on the same side as the PICC line)
  • shortness of breath.
  • tightness in your chest.

What is the risk of a blood clot with a PICC line? ›

Cancer patients have a higher risk of suffering a thrombotic event than the general population […]. In his article on PICC-related thrombosis, Chopra notes that the incidence of deep vein thrombosis (DVT) for PICCs is between 5% and 15% for inpatients and between 2% and 5% for outpatients.

What is a rare complication of peripherally inserted central catheter PICC? ›

Clinical discussion: Despite that the PICC placement seems to have many medical advantages in infants, it may cause life-threatening complications such as pneumothorax.

Can a PICC line cause a stroke? ›

Neurologic complications, including stroke, may result from upper-extremity PICC placement in either the arterial or venous system.

What are the symptoms of catheter occlusion? ›

Catheter occlusion is the most common noninfectious complication associated with long-term venous access. Symptoms of a catheter-related venous thrombosis may consist of neck vein distension, edema, tingling, or pain over the ipsilateral arm and neck, and a prominent venous pattern over the anterior chest.

What medication is used for occluded PICC? ›

Cathflo® Activase® (alteplase) is indicated for the restoration of function to central venous access devices as assessed by the ability to withdraw blood.

What medication is used for blocked PICC? ›

Urokinase is the most common thrombolytic used for unblocking central lines. Urokinase can be used in both scenarios. Note - urokinase will only work on blood related occlusions. If it does not work it may be due to drug precipitate.

What is the most worrisome complication that occurs with central lines? ›

Central Venous Catheter Complication #1: Damage to Central Veins. Damage to central veins, including injury, bleeding and hematoma (a swelling that consists of clotted blood), can occur during CVC placement. Studies shows that puncture of a vein occurs in 4.2–9.3% of catheter placements.

How long does it take for a central line to heal? ›

The area should heal in 10 to 14 days. To prevent infection, the area where the catheter was removed, should not be put under water. Do not swim in a pool or lake and do not use a hot tub or bathtub for 2 weeks, or as directed by your doctor.

What is the most common immediate complication of central line insertion? ›

Cardiac complications: Cardiac complications are considered to be one of the immediate complications seen in a central line insertion. Physicians will encounter arrhythmias during or as an immediate result of the insertion because of the guide wire coming into contact with the right atrium [14].

Can you live a normal life with a PICC line? ›

A PICC can stay in your body for as long as you need it for your treatment. Your healthcare provider will take it out when you don't need it anymore. Having a PICC should not keep you from doing most of your day-to-day activities. You will still be able to go to work or school.

Can a PICC line affect your heart? ›

For PICCs, this will usually means the tip moves inward, into the right atrium. This can cause the cardiac flutter feeling or your patient may complain of feeling a fast or irregular heartbeat. Retraction of the PICC by a very short distance may be needed to relieve these symptoms.

What should you avoid with a PICC line? ›


No strenuous activity or heavy lifting for first 48 hours after line is placed. Never use scissors to remove tape/dressing from around the line. Always tape line to your arm to prevent it from snag- ging on objects. Cover with plastic when showering so the dressing does not get wet.

What are three 3 possible complications associated with catheter insertion? ›

Other risks and side effects
  • injury to the urethra (the tube that carries urine out of your body) when the catheter is inserted.
  • narrowing of the urethra because of scar tissue caused by repeated catheter use.
  • injury to the bladder caused by incorrectly inserting the catheter.

Is a blocked catheter serious? ›

Catheter blockage is an emergency and needs to be fixed as soon as possible. If there is no urine draining into your bag, take the following steps: Check for and remove any kinks in the catheter or the drainage bag tubing. Check the position of your catheter and drainage bag.

How do you prevent catheter occlusion? ›

The most encouraging information on decreasing occlusion rate comes from experience with positive-pressure devices that attach to the hub of most catheter lumens and prevent retrograde blood flow and, consequently, decrease the risk of thrombus formation in the catheter lumen.

How do you sleep with a PICC line? ›

The best position to sleep in is on your back. This position prevents pressure on the port which may cause pain,” Lyon said. That means you might need to change your normal sleeping position. You might also find you're comfortable sleeping on your side.

Do you have to stay in hospital with a PICC line? ›

The procedure to insert the PICC line takes about an hour and can be done as an outpatient procedure, meaning it won't require a hospital stay.

What happens if PICC line won't flush? ›

If the PICC fails to give a blood return, flush the PICC with saline and ask the patient to move position, take a deep breath or cough whilst attempting to get a blood return.

When should you go to the ER with a PICC line? ›

Call Your Healthcare Provider Immediately If You Have:

Warmth, redness or swelling along the arm or PICC line insertion site. A tear or break in the PICC line catheter or tubing. The IV pump continues to alarm, even after flushing the catheter. Any leakage of IV fluid from around the PICC line insertion site.

Can you remove a PICC with a clot? ›

Deep Vein Thrombosis or DVT Upper Extremity or Upper Arm

Reasons for DVT are not known and this is not a typical outcome; however, when it does happen, the PICC or Midline should not be removed.

How long does it take for a blood clot to form in a PICC line? ›

Most of the clots developed in the first 10 days after the PICC went in. The team found that the narrower the PICC line a patient received, the lower their risk of a DVT.

What is central line occlusion? ›

A CVC occlusion can be partial, such that blood cannot be aspirated but infusion through the catheter is possible, or complete, such that neither aspiration nor infusion is possible. A CVC occlusion can arise from mechanical obstruction, precipitation of medications or parenteral nutrition, or thrombotic causes.

What are the signs of occlusion of a peripheral catheter? ›

Catheter occlusion is the most common noninfectious complication associated with long-term venous access. Symptoms of a catheter-related venous thrombosis may consist of neck vein distension, edema, tingling, or pain over the ipsilateral arm and neck, and a prominent venous pattern over the anterior chest.

What indicates catheter occlusion? ›

Pain or swelling at the catheter. Sluggish flow rate. An inability to infuse fluids or draw blood. Frequent pressure alarms—not responsive to patient repositioning or catheter flushing.


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