Major Complications Related to PICC and Midline Insertion
Condition: Upper Extremity Deep Vein Thrombosis
MeSH terms: Thrombosis; Venous Thrombosis; Upper Extremity Deep Vein Thrombosis
Study type: Observational [Patient Registry]

Summary: 
      Most important peripherally inserted central catheter (PICC) and Midline complications are
      thrombosis and catheter related blood stream infections. No large prospective observational
      study are present in literature about these topics. The aim of this multicenter prospective
      observational study is to analyze all the complications due to PICC and Midline insertion.
    

Detailed description: 
      A PICC line is a Peripherally Inserted Central Catheter. It is long, small, flexible tube
      that is inserted into a peripheral vein, typically in the upper arm, and terminates in a
      large vein in the chest to obtain a central intravenous access. A Midline catheter is similar
      to a PICC, but it is shorter in length (about 25 cm) and is inserted into a large vein in the
      upper arm, terminating not beyond the axillary vein. Midline catheters offer a longer dwell
      time and better hemodilution than the short peripheral IV catheters.The use of PICC and
      Midline has been increasing in outpatient and inpatient settings. Factors driving this
      increased use include their ease of insertion due to the placement into a peripheral vein-a
      safer approach-with the benefit of a central tip location appropriate for any osmolarity and
      pH infusions, a low reported incidence of infection, a better patient comfort, a durable
      venous access, and an easier nursing management in outpatient setting. PICC placement under
      ultrasound guidance can be carried out with no iatrogenic, mechanical complications
      associated with central venous catheter insertion in the neck or chest (pneumothorax,
      hemothorax etc…). Despite their many advantages, recent data suggest that PICCs are
      associated with venous thromboembolism. The incidence of symptomatic thrombosis ranges from
      1.9% to 8.4% and it increases to 75% considering also the asymptomatic one. The risk factors
      that predispose a patient to the development of a thrombotic complication are: the caliber of
      the device (≥5Fr), the position of the catheter tip, the insertion of the PICC in a paretic
      limb, a history of venous thrombosis, the residence time of the device and the presence of an
      oncological pathology. The second major complication due to the PICC insertion is the
      catheter related blood stream infection (CRBSI). The incidence of PICC-BSI in literature
      ranges from 2.0 per 1000 catheter days to 3.1 per 1000 catheter days. This disparity stems
      from the fact that there is no single definition of catheter infection. Multiple factors
      associated with patient and catheter care have been identified has having an increased risk
      of CRBSI and are amenable to preventive measures. Independent risk factors for PICC BSIs
      included congestive heart failure, intrabdominal perforation, Clostridium difficile
      infection, recent chemotherapy, presence of tracheostomy, and type of catheter (double or tri
      lumen). Limited data exists regard prospective observational study on deep vein thrombosis
      and CRBSI related to PICC and Midline insertion, including the different calibers of the
      device and the presence of single or multiple lumen.

      The investigators designed a multicenter prospective observational study to determine the
      incidence of deep vein thrombosis, related/associated catheter blood stream infections and
      the incidence of all the minor complications due to PICC and Midline insertion.
    

Intervention name(s): PICC and Midline
Intervention type(s): Device
Intervention description(s): Peripherally inserted central venous catheter
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study will be conducted in all the patients undergoing PICC or Midline catheter
        insertion which fall in the inclusion criteria
      
Keywords: peripherally inserted central venous catheter; depp vein thrombosis; related blood stream infections; midline