Role of peripherally inserted central catheters (PICC) in home and in-hospital parenteral nutrition

A central venous access is needed in most patients who are candidates for parenteral nu- trition. The technology of these devices has changed considerably since their initial use, one of the most recent trends being the delivery of parenteral nutrition through a peripherally inserted central catheter. Usually composed of silicone elastomer or second- or third-generation polyurethane poly- mers, peripherally inserted central catheters are 50-60 cm long, with one or more lumens, and may be inserted either in the antecubital space by blind cannulation of the cephalic or basilic vein, or at mid- arm, by ultrasound guidance of the basilic, brachial or cephalic veins. The micro-introducer technique in combination with ultrasound guidance has improved the mid-arm positioning of these catheters. The low rate of infectious complications, equal to or even lower than with other central lines, together with the ease of placement and the avoidance of pneumothorax and arterial puncture, have made pe- ripherally inserted central catheters a reasonable alternative to other central catheters for parenteral nutrition in hospitalized patients. Peripherally inserted central catheters have shown only an increased incidence of local complications such as leaking, phlebitis and malpositioning when compared to other tunneled and non-tunneled catheters. These are acceptable risks in most patients in whom a peripher- ally inserted central catheter is indicated, as this type of catheter offers other clear advantages. Although the peripherally inserted central catheter has become the standard of care for vascular ac- cess devices for home parenteral nutrition at many institutions, a randomized, prospective study of pe- ripherally inserted central catheter versus long-term central catheters is urgently needed in order to establish if the peripherally inserted central catheter is also a good alternative for patients needing home parenteral nutrition. (Nutritional Therapy & Metabolism 2009; 27: 55-61)