Use of peripherally inserted central catheters in the management of recalcitrant maxillofacial infection

The most common short-term method for the delivery of parenteral antimicrobial therapy in an acute hospitalized patient has traditionally been via a short peripherally inserted intravenous cannula. This approach, however, has significant limitations, particularly in patients who require prolonged, uninterrupted intravenous access. In this article, we report on our experience with an alternative method used to establish and maintain medium- to long-term intravenous access utilizing a peripherally inserted central catheter (PICC) to treat patients presenting with aggressive or recalcitrant maxillofacial head and neck infections.

We undertook a retrospective review of the medical records of 100 consecutive patients admitted to a tertiary referral teaching hospital, during the period February 2006 to February 2007, with a primary diagnosis of infection in the oral and maxillofacial region. We identified 6 patients in whom a PICC was used in the treatment of the condition. We also analyzed data obtained from an audit conducted by our infectious diseases unit. This audit recorded the outcome of 849 nurse-placed PICCs in the department's ambulatory intravenous therapy service. Using this data, we also performed a PICC line survival analysis and in so doing, calculated the complication rates.

In our series, the delivery of PICC-based therapy accounted for 6% of the treatment provided for all cases of maxillofacial sepsis. This included 3 cases of actinomycosis, 2 cases of odontogenic osteomyelitis, and 1 case of a zoonotic facial abscess/cellulitis. In this series of patients, catheters remained in situ for an average of 33 days (range 12-42 days). The audit data demonstrated that more than 75% of nurse-placed PICCs are functional without complication at 60 days. The most common complication was phlebitis (1 per 1,000 catheter days). Infection was rare (0.2 per 1,000 catheter days).

PICC is a safe and most reliable means of administering medium- to long-term intravenous antibiotics. We feel PICC-based therapy should be considered in the management of select patients with aggressive or recalcitrant maxillofacial head and neck sepsis.