Tricuspid valve vegetation related to leaflet injury: a unique problem of catheter malposition.

The use of peripherally inserted central catheters (PICCs) has expanded substantially for drug delivery in clinical practice in recent years. However, PICC lines expose patients to potential complications associated with an increasing incidence of infective endocarditis. We herein report a case of a 57-year-old woman who was diagnosed with tricuspid valve endocarditis by echocardiography. The most probable cause was direct injury to the tricuspid valve by the tip of a PICC line with excessive length in the right heart. The vegetation disappeared with conservative treatment after removal of the PICC line. Clinicians must maintain vigilance against any suspected PICC-related infection in febrile patients with a PICC line. For echocardiographers, precise evaluation of the position of the PICC tip and the detection of endocarditis is important to devise the optimal clinical strategy.

Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study.

BACKGROUND: Peripherally Inserted Central Catheters (PICCs) are widely used for hospitalized patients and among outpatients. Despite many advantages, PICC-related complications can occur such as infection, thrombosis or mechanical complications. We aimed to evaluate rates and nature of PICC-related complications from insertion to removal and analyze risk factors of complications at baseline and during healthcare. METHODS: We performed a prospective cohort study looking at PICC-related complication rates in the inpatient and outpatient settings of 163 patients over a 7-month period. Pertinent patient demographics as well as catheter-related factors were collected. The data were analyzed to identify catheter-related complications using univariate and multivariate analysis. RESULTS: One hundred ninety-two PICCs were monitored for a total of 5218 PICC-days (3337 PICC-days for inpatients, 1881 PICC-days for outpatients). The overall complication rate was 30.2% (11.1 per 1000 PICC-days) with a mean time to onset of 16.1 days. Complications included occlusion (8.9%), accidental withdrawal (8.9%), infections (6.3%) including 9 local infections (4.7%) and 3 bloodstream infections (1.6%), venous thrombosis (1.6%) and hematoma (1%). Complication rate was higher in the hospitalization setting (36.1%; 14.38 per 1000 PICC-days) than in the outpatient setting (19.4%; 3.19 per 1000 PICC-days). Multivariate logistic regression analysis showed that the occurrence of occlusion was significantly associated with an age > 65 years (OR = 4.19; 95% CI [1.1-15.81]) and the presence of a pre-occlusive event the week before PICC removal (OR = 76.35; 95% CI [9.36-622.97]). CONCLUSIONS: PICCs appear safe in the inpatient and outpatient settings with low rates of infectious or thrombotic complications. Occlusion and accidental withdrawal were the most common complications, with age > 65 and catheter pre-occlusive event associated with an increased likelihood of catheter occlusion.