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Safety versus Problems of TPN Administration via PICC lines


In some hospital settings, PICCs have has become the preferred alternative over central venous lines inserted in the neck region for administration of total parenteral nutrition therapy (TPN). This is due to three main factors: cost-effectiveness, ease of insertion and a significantly small incidence of major complications.

Cost-effectiveness has become vital in these days of managed healthcare. As physician reimbursements for central line placements and PICC have steadily declined, specially trained and certified nursing teams have now been delivering effective PICC placement services beginning with insertion through to continuing care and education after the lines have been placed. The cost effectiveness is proven through numerous studies(1).

Ease of insertion compared to subclavian or internal jugular placements not only means greater cost-effectiveness in terms of the hours saved in trying to secure intravenous access, but also making the procedure much more tolerable for patients. With PICC lines, the failure rate is significantly lower. There is significantly less tissue trauma and complication risks are substantially lower. In addition, risk for infection is greatly decreased related to the mere placement of the line - neck versus upper arm for PICC lines.

Major central venous complications include a hemothorax, pneumothorax, cardiac tamponade, or rupture of blood vessels which are not typically present in PICC line placement. In addition, there are fewer migrations of catheter tips compared to central catheterization. With decreased complications, patients in a sub-acute setting, who are much likely to be conscious and eager to be discharged, experience much less anxiety. It also makes monitoring easy which is very advantageous use in a domestic setting.

The only drawback of PICC in comparison to central lines appear to be venous thrombophlebitis (10-30%)(1) and line occlusion. These complications may result in declotting an occluded line, which is highly successful and non-invasive, restarting lines at more frequent intervals, or in rare instances, conversion to central catheterization. In addition, PICCs may also be difficult to insert in certain patients, for example, those with very poor venous access, gross obesity or exhaustion of viable veins due to repeated cannulation. However, placements of other types of lines are subject to the same difficulties.

Weighing risks versus benefits, a PICC is most suitable for the administration of TPN in the vast majority of cases. With improved biomaterials and better topical and systemic anticoagulation management, the use of PICC is likely to become more widespread in the coming years.



(1) Cowl CT, Winstock J V et al (2000) Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters Clinical Nutrition, Volume 19, Issue 4, August 2000, Pages 237-243


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