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Peripherally inserted central catheter (PICC) fracture and embolization in the pediatric population
Lionel M L Chow1, Jeremy N Friedman, Colin Macarthur
1Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Objectives:
To document and characterize fracture and embolization of peripherally inserted central catheters (PICCs) in the pediatric population and define predisposing features for these complications.
Study Design:
A case series was assembled by examining the records of PICC insertions in a single tertiary care pediatric hospital over a 6-year period. A control group was selected by simple random sampling of eligible PICC insertions.
Results:
Among approximately 1650 PICCs, 11 children were identified with a fractured line, requiring invasive retrieval. Patient characteristics did not reveal any specific risk factors compared with the control group. Likewise, catheter size, site, and medications infused through the line were not significant predisposing factors for fracture. However, duration of placement and a line complication (blockage of the line or leaking at the insertion site) were significantly associated with catheter fractures. In all cases, the embolized line fragment was successfully retrieved by percutaneously inserted catheters and snares. No major complications arose from these fractured catheters.
Conclusions:
Fracture and embolization of PICCs occur and may pose a potential risk of serious consequences. It is prudent to list PICC fracture as a rare but potentially serious complication of this device when obtaining informed consent for its insertion.