Off Label use of Peripherally Inserted Central Catheters – Procedural safety compared with PICCs

Introduction The use of peripherally Inserted Central Catheters (PICCs) has become extremely popular in several clinical situations. In cases that basilic and brachial veins are unavailable due to the small vein diameter, previous lymph node dissection in both axillas  due to breast cancer surgery or other local contraindications, the off label placement of PICCs in the internal jugular or the axillary vein and tunneling of the catheter in the infra-clavicular area is an acceptable option. The aim of the present study was to assess the safety of the off label use of PICCs and compare the incidence of catheter related complications between the group of patients with PICC and those with off label PICC.

Method A retrospective analysis of the procedures of PICC placement that were placed by the two nurses of a university nurse led vascular access unit of a 290 bed general oncology hospital was performed.

Results A total of 476 procedures were performed. A PICC was placed at 433 patients and an off label PICC through the internal jugular or the axillary vein was placed in 43 patients. The comparison of both immediate and late complications incidence showed a statistically not significant but clinically important lower complication incidence in the off label PICC group of patients. In the PICC group central line associated bloodstream infection (CLABSI) incidence was 1.8%, tunnel infection was 1.8%, catheter related thrombosis (CRT) was 0.7% and catheter occlusion was 1.8% whereas in the off Label PICC group the incidence of CLABSI was 2.3% and 0% respectively for all the other late complications.

Discussion & Conclusion Off label placement of PICCs is technically feasible for experienced VA nurses with high levels of procedural safety and low late complication rates indicating that perhaps is the best option when PICC placement at the arm is contraindicated.