Saturday December 09, 2006
PICC or CVC ?

Lately, there has been a trend particularly in community hospital settings to use PICCs (Peripherally inserted central venous catheters) more and more than CVCs (central venous catheters). There is no head to head trial available to compare them particularly in ICUs but it appears that PICC provides no added benefit or actually may be less efficacious and even harmful in comparison to CVC. Major disadvantages

• more vulnerable to thrombosis
• more vulnerable to dislodgment
• hard in drawing blood specimens
• clogged more easily
• has only 2 ports
• can't measure CVP (or need extra measures) * see related pearl below
• not good for fluid resuscitation because of its longer length.
• in patients with impending renal failure, it may not respect the preservation of upper-extremity veins which is needed for fistula or graft implantation.

Also, Dr. Safdar and Dr. Maki last year reported in chest that PICCs used in high-risk hospitalized patients are associated with a rate of catheter-related BSI similar to conventional CVCs placed in the internal jugular or subclavian veins.

The advantages of PICC are: they can be easily put by non-physician 'line team' and could be a choice of intravenous access in very obese patients.


Related previous Pearl: Can we measure CVP via PICCs ?



Reference: click to get abstract/article

1. Risk of Catheter-Related Bloodstream Infection With Peripherally Inserted Central Venous Catheters Used in Hospitalized Patients - Chest. 2005;128:489-495.

Friday December 08, 2006


Q: Which common blood test in ICU may be misleading if you use hetastarch (hespan) as volume resuscitation?


A; Amylase

Hetastrach gets attached to amylase and reduce its clearance by kidney and may cause significant elevated amylase level for about one week after infusion. It is a benign effect but may get misdiagnosed as pancreatitis. Differential can be confirmed by lipase level which remains normal.