More Care Can Lead To More Complications
I have a patient that comes in every so often that demands a PICC line (peripherally inserted central catheter). PICC lines are convenient for patients and nurses and doctors because they can be used to obtain blood without needing to stick the patient on a daily basis. They can be kept in for weeks and weeks and weeks with proper care. They can maintain adequate IV access when old ladies and drug addicts present with poor veins. Often they save the patient during acute decompensations of their critical illness. However, they come with frequent complications. I have had my share of patients return to the hospital with sepsis from their PICC line.
Nephrologists hate them because the veins around the catheter often clot off leading to fewer choices for AV fistulas in end stage renal failure. They can cause deep venous thrombosis requiring the need for long term anticoagulants. Here is a classic example of why more is not always better. What you see here is the tip of a PICC line that has looped up and knotted on itself. I have never seen this before. Normally the line can simply be pulled out of the body with a quick tug. In this case, it required a surgical cut down of the axillary vein. In a constant desire to make our lives simpler, often the risks can outweigh the benefits.
*This blog post was originally published at A Happy Hospitalist*
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