AHRQ WebM&M: Morbidity and Mortality Rounds on the Web

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AHRQ WebM&M: Morbidity and Mortality Rounds on the Web

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Preventing PICC Complications: Whose Line Is It?

Commentary by Nancy Moureau, BSN, RN, CRNI, CPUI, VA-BC

The Case

A 55-year-old woman with myasthenia gravis, hypertension, and hypothyroidism presented to the emergency department with 1 week of progressive left arm swelling, neck pain, and fevers. For the past year, the patient was receiving treatment for myasthenia gravis with intravenous immunoglobulin (IVIG) through a peripherally inserted central catheter (PICC). On admission, she was found to have extensive catheter-related thrombosis in the subclavian, axillary, and internal jugular veins. Her blood cultures subsequently grew staphylococcus aureus and she was diagnosed with endocarditis and osteomyelitis of her cervical spine. Her hospital course was complicated by sepsis, acute respiratory distress syndrome (ARDS), and multiorgan failure. The patient ultimately died during the hospitalization.

The hospital's quality committee reviewed the case. They noted that the patient had a PICC line placed at one facility but was receiving IVIG infusions at a different hospital closer to home. Questions were raised about who had responsibility for the line, whether it should have been replaced periodically to reduce infection risk, and what other strategies might have prevented this outcome.

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