Question

What are the contraindications of PICC line placement?

Answer 1

Contraindications of PICC line placement include the presence of skin infections at the insertion site or occluded veins. WHO highlights the significant risk of bloodstream infections related to catheter use, which can lead to severe complications. The case of Barbara exemplifies signs of catheter-related infection, which was managed through antiseptics, fresh dressings, and antibiotics.

Step-by-step explanation:

The contraindications of Peripherally Inserted Central Catheter (PICC) line placement can be critical, as the insertion of a central venous line carries the risk of infection. Health professionals must be aware of the possibility of bloodstream infections associated with catheter use. The World Health Organization (WHO) notes the significance of infections related to venous catheters, resulting in up to 80,000 cases annually in the US, with about 20,000 deaths. This is often the result of human error when the necessary steps to prevent infection are not meticulously followed, thus endangering patients by increasing the risk of complications such as a longer illness, additional surgery, or even death.

In general, contraindications for PICC line placement include patient conditions such as skin infections at the proposed insertion site, thrombosed or occluded peripheral veins which would prevent the successful placement of the line, and patient-specific conditions that preclude the use of anticoagulants which are sometimes necessary to maintain catheter patency.

As evidenced by the clinical case of Barbara, a 43-year-old patient with metastatic inflammatory breast cancer, signs of localized infection such as redness, warmth at the catheter site, and fever indicate a possible catheter-related infection. She was appropriately treated with a topical antiseptic, fresh dressing, and a course of antibiotics (i.e., oxacillin) to address the infection.

Answer 2

The contraindications of PICC line placement include active infection or sepsis, blood clotting disorders, anatomical abnormalities, and patient refusal.

Step-by-step explanation:

Placement of a PICC line (Peripherally Inserted Central Catheter) is generally safe and well-tolerated, but there are specific contraindications for its insertion:

1. Active infection or sepsis: Inserting a PICC line in a patient with an active infection can increase the risk of spreading the infection further.
2. Blood clotting disorders: People with clotting disorders, such as thrombocytopenia or coagulopathy, may have an increased risk of bleeding or blood clot formation at the PICC line insertion site.
3. Anatomical abnormalities: Some anatomical abnormalities, such as severe peripheral arterial disease or venous stenosis, may make it difficult to safely insert a PICC line.
4. Patient refusal: If a patient refuses PICC line placement or has expressed concerns or preferences against it, their decision should be respected.