Acute ischaemia of the upper limb following peripherally inserted central catheter—a venous to arterial complication cascade

Abstract

Peripherally inserted central catheters (PICC) are useful access devices that allow for longer-term intravenous access. This allows patients requiring an extended period of intravenous medication to have this administered without the need for repeat vascular punctures. Even minimally invasive procedures such as line insertion come with risks. Of particular interest to this article is a limb threatening complication soon after line placement. We discuss the PICC line catheter tip as the likely cause for arrhythmia that lead to an embolic occlusion of an upper limb and required acute surgical intervention for limb salvage. We stress the rapid sequence of events that lead to this ultimate complication. We also stress the importance for all clinicians to be aware of these risks and take a cautious approach as the majority of patients requiring longer-term access are already at greater risks of thromboembolic disease due to their comorbidities.

Safety and Efficacy of Peripherally Inserted Central Catheter Placement by Surgical Intensivist–Led Vascular Access Team

“…Therefore, this safe and cost-effective procedure is widely performed at the bedside by experienced nurses or technicians [ 7 , 8 ]. However, unexpected events, including bleeding due to vessel injury, nerve injury, ischemia, and arrhythmia, may occur [ 9 , 10 ], and the surgical intensivist is more likely to resolve it more quickly than other medical personnel. For example, in two severely obese patients of this study, the guidewire became stuck in the muscle and cut in the middle.…”

Revascularization in acute limb arterial embolism

“…Описва се 59-годишна болна с планова периферна инсерция на централен катетър под ултразвуков контрол в дясната ръка с цел дълготрайно интравенозно въвеждане на химиотерапевтични медикаменти (8). Върхът на катетъра е вероятната причина за настъпилата аритмия, довела до емболично запушване на горния крайник и налагаща незабавна хирургическа намеса за съхраняването му.…”