Perils of the PICC: Peripherally Inserted Central Catheter-Associated Complications and Recommendations for Prevention in Clinical Practice-A Narrative Review

Abstract

Background: Peripherally inserted central catheters (PICCs) are becoming an increasingly utilised alternative to traditional central venous access devices. Their uptake, particularly among oncology patients, is due to their growing ease of access, suitability for medium-term use and perceived safety profile. However, PICCs can be a source of severe and life-threatening complications such as central line-associated bloodstream infection (CLABSI), deep vein thrombosis (DVT), pulmonary embolism (PE), malpositioning, dislodgement, and occlusion.

Methods: This narrative was constructed from a literature review of the PubMed database, utilising MESH terms for peripherally inserted central catheters, percutaneous central catheters, PICC, and complications. Randomised controlled trials, systematic reviews, and meta-analyses published between 2015 and 2025 were included. Additional articles were obtained through targeted PubMed searches or from references within previous articles.

Results: Major periprocedural complications were seen in 1.1% of PICC insertions, CLABSI in 1.4-1.9%, venous thrombosis embolism (including PE) in 2.3-5.9%, and malpositioning in 7.87%. The overall PICC complication incidence was 9.5-38.6%, which is greater than that of centrally inserted central venous access. A higher BMI, diabetes mellitus, chronic renal failure, and malignancy were the most significant predictive factors for PICC-associated complications.

Conclusions: PICC complications are common, occurring more frequently than other forms of central venous access, and may lead to significant morbidity and mortality. Appropriate assessment of patient risk factors and optimisation strategies may reduce complication rates.

Keywords: anaesthesia; central line-associated bloodstream infection; complication; critical care; incidence; intensive care; peripherally inserted central catheters; prevention; review; thrombosis.

Figure 1

Peripheral venous sites of PICC line insertion, i.e., basilic vein, brachial vein, and cephalic vein. Illustration from Anatomy & Physiology, Connexions Web site. Accessed 5 August 2025. http://cnx.org/content/col11496/1.6—with permission [28].