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Original article

Vol. 147 No. 1920 (2017)

The role of a surveillance programme for introducing peripherally inserted central catheters: a 2-year observational study in an academic hospital

Cite this as:
Swiss Med Wkly. 2017;147:w14441



In our hospital, a previous attempt to introduce peripherally inserted central catheters (PICC) was aborted after a nonsystematic approach, seemingly accompanied by high rates of complications. The goal of this new interdisciplinary project was to introduce PICCs in an academic hospital, with an embedded interdisciplinary surveillance programme for both infectious and noninfectious outcomes.


We prospectively collected data for this surveillance study from all patients who underwent PICC insertion from 1 January 2014 and had the catheter removed by 31 December 2015 in our 950-bed academic hospital (Bern University Hospital, Switzerland). Infectious complications were defined according to Centers for Disease Control and Prevention / National Healthcare Safety Network criteria. PICCs were restricted to cancer and infectious disease patients, and were followed up irrespective of the management setting (inpatient, outpatient or intermittently hospitalised after insertion). An interdisciplinary team reviewed the outcomes on a routine basis and discussed changes to the process to improve outcomes, if necessary.


One hundred and thirty-five PICCs were inserted in 124 patients, the majority of whom were patients from the medical oncology department (n = 107, 86.3%). Indications for PICC insertion included: chemotherapy (n = 97, 71.9%), antibiotic therapy (n = 24, 17.8%), total parenteral nutrition (n = 8, 5.9%), blood product transfusion (n = 4, 3.0%) and palliative care (n = 2, 1.5%). During a total of 10 402 catheter-days (median dwell time 62 days), there were five central line-associated bloodstream infections, including one mucosal barrier injury laboratory-confirmed bloodstream infection and two exit-site infections, yielding incidence rates of 0.48 and 0.19 infections per 1000 catheter-days, respectively. Incidence rates were 0.67 per 1000 catheter-days (n = 7) for radiologically documented deep venous thrombosis, 0.96 (n = 10) for tip dislocation and 0.67 (n = 7) for catheter occlusion. The overall rate of complications was 4.5 per 1000 catheter-days. Seventeen catheters (12.6%) were removed because of any complication.


We successfully introduced PICCs in an academic hospital by implementing a systematic surveillance programme for complications. Both infectious and noninfectious complications were rare. Infection prevention specialists should be actively involved during the introduction of new intravascular devices in order to provide quality indicators and assure patient safety.


  1. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al.; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39(4, Suppl 1):S1–34.
  2. Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA Cancer J Clin. 2008;58(6):323–46.
  3. Chopra V, Flanders SA, Saint S, Woller SC, O’Grady NP, Safdar N, et al.; Michigan Appropriateness Guide for Intravenouse Catheters (MAGIC) Panel. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015;163(6, Suppl):S1–40.
  4. Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature. Acta Oncol. 2013;52(5):886–92.
  5. Walker G, Todd A. Nurse-led PICC insertion: is it cost effective? Br J Nurs. 2013;22(19):S9–15.
  6. Walshe LJ, Malak SF, Eagan J, Sepkowitz KA. Complication rates among cancer patients with peripherally inserted central catheters. J Clin Oncol. 2002;20(15):3276–81.
  7. Rhee Y, Heung M, Chen B, Chenoweth CE. Central line-associated bloodstream infections in non-ICU inpatient wards: a 2-year analysis. Infect Control Hosp Epidemiol. 2015;36(4):424–30.
  8. Chopra V, Ratz D, Kuhn L, Lopus T, Chenoweth C, Krein S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med. 2014;127(4):319–28.
  9. Pongruangporn M, Ajenjo MC, Russo AJ, McMullen KM, Robinson C, Williams RC, et al. Patient- and device-specific risk factors for peripherally inserted central venous catheter-related bloodstream infections. Infect Control Hosp Epidemiol. 2013;34(2):184–9.
  10. Ajenjo MC, Morley JC, Russo AJ, McMullen KM, Robinson C, Williams RC, et al. Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients. Infect Control Hosp Epidemiol. 2011;32(2):125–30.
  11. Centers for Disease Control (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central line-associated Bloodstream Infection). 2015; Available at: Accessed 3 December 2015.
  12. Centers for Disease Control (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC). CDC/NHSN Surveillance Definitions for Specific Types of Infections [Internet]. [cited 2015 Mar 26]. Available from:
  13. Chopra V, O’Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013;34(9):908–18.
  14. Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest. 2005;128(2):489–95.
  15. Chopra V, Anand S, Hickner A, Buist M, Rogers MA, Saint S, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet. 2013;382(9889):311–25.
  16. Cotogni P, Barbero C, Garrino C, Degiorgis C, Mussa B, De Francesco A, et al. Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study. Support Care Cancer. 2015;23(2):403–9.
  17. Curto-García N, García-Suárez J, Callejas Chavarria M, Gil Fernández JJ, Martín Guerrero Y, Magro Mazo E, et al. A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study. Support Care Cancer. 2016;24(1):93–101.
  18. Nolan ME, Yadav H, Cawcutt KA, Cartin-Ceba R. Complication rates among peripherally inserted central venous catheters and centrally inserted central catheters in the medical intensive care unit. J Crit Care. 2016;31(1):238–42.
  19. O’Brien J, Paquet F, Lindsay R, Valenti D. Insertion of PICCs with minimum number of lumens reduces complications and costs. J Am Coll Radiol. 2013;10(11):864–8.
  20. Yap Y-S, Karapetis C, Lerose S, Iyer S, Koczwara B. Reducing the risk of peripherally inserted central catheter line complications in the oncology setting. Eur J Cancer Care (Engl). 2006;15(4):342–7.
  21. Alexandrou E, Spencer TR, Frost SA, Mifflin N, Davidson PM, Hillman KM. Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates--a report from 13 years of service*. Crit Care Med. 2014;42(3):536–43.
  22. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.
  23. Shrestha NK, Shrestha J, Everett A, Carroll D, Gordon SM, Butler RS, et al. Vascular access complications during outpatient parenteral antimicrobial therapy at home: a retrospective cohort study. J Antimicrob Chemother. 2016;71(2):506–12.
  24. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, et al.; Society for Healthcare Epidemiology of America. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753–71.
  25. Cheong K, Perry D, Karapetis C, Koczwara B. High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours. Intern Med J. 2004;34(5):234–8.
  26. Bertoglio S, Faccini B, Lalli L, Cafiero F, Bruzzi P. Peripherally inserted central catheters (PICCs) in cancer patients under chemotherapy: A prospective study on the incidence of complications and overall failures. J Surg Oncol. 2016;113(6):708–14.
  27. Freeman JT, Elinder-Camburn A, McClymont C, Anderson DJ, Bilkey M, Williamson DA, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol. 2013;34(1):89–92.
  28. Chaftari A-M, Jordan M, Hachem R, Al Hamal Z, Jiang Y, Yousif A, et al. A clinical practical approach to the surveillance definition of central line-associated bloodstream infection in cancer patients with mucosal barrier injury. Am J Infect Control. 2016;44(8):931–4.
  29. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45. Corrected in Clin Infect Dis. 2010;50(7):1079 (Dosage error in article text)
  30. Lee AYY, Levine MN, Butler G, Webb C, Costantini L, Gu C, et al. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol. 2006;24(9):1404–8.
  31. Zhang X, Huang J-J, Xia Y, Li C-F, Wang Y, Liu P-P, et al. High risk of deep vein thrombosis associated with peripherally inserted central catheters in lymphoma. Oncotarget. 2016;7(23):35404–11.
  32. Ahn DH, Illum HB, Wang DH, Sharma A, Dowell JE. Upper extremity venous thrombosis in patients with cancer with peripherally inserted central venous catheters: a retrospective analysis of risk factors. J Oncol Pract. 2013;9(1):e8–12.
  33. Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(6):724–34.
  34. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.
  35. O’Neil C, Ball K, Wood H, McMullen K, Kremer P, Jafarzadeh SR, et al. A Central Line Care Maintenance Bundle for the Prevention of Central Line-Associated Bloodstream Infection in Non-Intensive Care Unit Settings. Infect Control Hosp Epidemiol. 2016;37(6):692–8.
  36. Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics. 2013;132(6):e1609–15.
  37. Chittick P, Azhar S, Movva K, Keller P, Boura JA, Band J. Early onset versus late onset peripherally inserted central venous catheter infections: an analysis of risk factors and microbiology. Infect Control Hosp Epidemiol. 2013;34(9):980–3.
  38. Safdar N, O’Horo JC, Ghufran A, Bearden A, Didier ME, Chateau D, et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis*. Crit Care Med. 2014;42(7):1703–13.
  39. Kim-Saechao SJ, Almario E, Rubin ZA. A novel infection prevention approach: Leveraging a mandatory electronic communication tool to decrease peripherally inserted central catheter infections, complications, and cost. Am J Infect Control [Internet]. 2016 May [cited 2016 May 22]; Available from:

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