Are PICC Lines and Midline Catheters Safe?

Central venous access catheters (CVACs), including PICC lines (peripherally inserted central catheters) and midline catheters, offer a convenient way to deliver medications, fluids, and nutrients directly into a patient's bloodstream. They're lifelines for many patients undergoing long-term treatments, but recent studies and lawsuits highlight potential risks.

What are PICC lines and midline catheters used for?

PICC lines (peripherally inserted central catheters) and midline catheters are thin, flexible tubes inserted into a vein to deliver medications, fluids, and nutrients directly into a patient's bloodstream.

Patients with the following conditions may be candidates for a PICC line or midline catheter, depending on their specific needs and treatment plan discussed with their doctor:

• Patients undergoing chemotherapy
• Patients requiring long-term antibiotic therapy
• Patients needing frequent blood draws for monitoring
• Patients requiring parenteral nutrition
• Patients who have difficulty accessing peripheral veins

Unlike traditional IVs placed in smaller veins near the hand, these catheters reach the larger central veins closer to the heart. This placement offers several advantages for patients requiring long-term treatment or those who have difficulty accessing peripheral veins.

• Long-Term Convenience: For patients undergoing treatments like chemotherapy or chronic antibiotic therapy, PICC lines can stay in place for weeks or even up to 18 months. This eliminates the need for repeated uncomfortable needle insertions that can damage smaller veins.
  
  
• Delivering Powerful Treatments: PICC lines can safely administer medications that can irritate smaller veins. This includes chemotherapy drugs, some antibiotics, and parenteral nutrition (liquid food delivered through a vein).
  
  
• Faster Medication Action: Central veins have a larger diameter and faster blood flow compared to peripheral veins. Medications reach their target site quicker through a PICC line, leading to a faster therapeutic effect.
  
  
• Blood Draws Made Easy: PICC lines allow for easy access to blood for frequent blood tests, especially beneficial for patients undergoing treatments that require close monitoring.
  
  
• Blood Transfusions Simplified: PICC lines can be used for blood transfusions, particularly for patients who may need repeated transfusions.

Are PICC lines and midline catheters safe?

While PICC lines and midline catheters offer undeniable convenience for delivering long-term medications and fluids, recent studies raise concerns about potential complications. Here's why careful consideration and informed decision-making are crucial.

The Risks of Misplacement:

Accurate placement is paramount for PICC line safety. A misplaced line in the carotid artery instead of the jugular vein can have devastating consequences. Medications could be inadvertently delivered to the brain, leading to life-threatening complications like strokes, seizures, paralysis, and even permanent brain damage.

Serious Health Risks Associated with CVACs:

Millions of patients rely on CVACs (central venous access catheters, which include PICC lines and midline catheters) each year. However, these long-term placements are linked to several health risks:

• Blood Clots: A 2020 study revealed a concerning statistic: nearly a third of patients with CVACs developed sepsis, a life-threatening condition often triggered by blood clots.

• Infections: The materials used in some CVACs, such as polyurethane and silicone, can deteriorate over time, creating a breeding ground for bacteria and increasing the risk of infections.

• Nerve Damage: Choosing the brachial vein as an insertion site for a PICC line significantly elevates the risk of nerve injury. 

• Broken Catheter: While uncommon, fractured or migrated catheters can lead to serious consequences, including arrhythmias, cardiac issues, pulmonary embolism, and sepsis. 
  

• Air Embolism: Air embolism, a rare but potentially life-threatening complication, can occur if air enters the bloodstream through the catheter. This can damage vital organs like the kidneys, liver, and brain.

The high cost of catheter complications

The financial and personal impact of complications from PICC lines and midline catheters can be devastating.

• Healthcare Costs: These complications are estimated to cost the healthcare system around $4.5 billion each year.
  

• Individual Costs: Patients can face medical bills in the tens of thousands of dollars, lost wages, and ongoing pain and suffering due to infections, blood clots, or other complications.

Manufacturers May Be Putting Profits Over Safety

Many PICC lines and midline catheters lack safer technologies that could significantly reduce these risks. For example, catheters with antimicrobial and antithrombotic coatings have been around since 2013, but many manufacturers don't use them to save money.

Manufacturers of PICC lines and Midlines and Implantable Ports include:

CR Bard:

• PowerPICC catheter
• PowerPICC SOLO
• Poly RADPICC
• PowerGroshong PICC silicone catheter
• Poly Per-Q-Cath Triple Lumen PICC
• Silicone Dual Lumen RadPICC catheter
• Groshong Dual Lumen PICC
  

Angiodynamics/Navilyst:

• Morpheus
• Vaxcel
• Xcela
• PASV technology
  

Teleflex:

• Power Injectable PICC
• ArrowEvolution antimicrobial PICC (chlorhexidine and silver sulfadiazine) with antithrombotic performance

Medcomp:

• Vascu-PICC II
• Pro-PICC CT

Cook Medical:

• Spectrum Turbo-Ject PICC
• Silicone PICCs Antimicrobial

Lawsuits and the push for safer technology

A growing number of lawsuits are being filed against manufacturers alleging they prioritize profits over patient safety by not incorporating these safer designs. These lawsuits often focus on:

• Misplaced Catheters: A lawsuit details a case where a 27-year-old man tragically died after a PICC line was mistakenly placed in an artery instead of his external jugular vein. The lawsuit alleges this error led to complications like stroke, paralysis, and heart attack.
  
  
• Failure to Implement Safer Designs: Another lawsuit highlights the case of a newborn baby boy who suffered brain damage and arm amputation after a PICC line catheter was left misplaced for days. 

These lawsuits argue that readily available safer designs could have prevented such harm.

Holding manufacturers accountable

If you or someone you love has suffered complications from a PICC line or midline catheter, you may be entitled to compensation for your damages. An attorney specializing in medical device lawsuits can advise you of your legal rights and help you navigate the process of seeking compensation.

Lawsuits not only aim to recover compensation for patients who have been injured, but also to hold manufacturers accountable for their products and encourage them to prioritize patient safety by using safer materials and designs in PICC lines and midline catheters.

As more and more patients come forward about complications from PICC lines and midline catheters, there is a growing movement to enact stricter regulations and safer medical practices to protect patients in the future.