Prophylactic antibiotics have not been consistently proven to prevent infections, in fact, their use is not recommended. Other factors that increase the risk of infection are those that are not tunneled and those with multiple lumens. Infection rates are higher for PICCs placed in the antecubital fossa compared to those placed in the upper arm (i.e., basilic vein). Though past studies have argued for lower infection rates with PICCS among critically ill patients, recent publications, in including a 2016 study comparing 200 PICCs and 200 CICCs, have shown no difference. There is still question whether PICCS or centrally inserted venous catheters (CICCs) have lower infection rates. This could be because patients managed on an outpatient basis are healthier in general, and their catheter is accessed less frequently. However, it is found to be higher in the inpatient setting (2. The cumulative incidence of CRBSIs for PICCs is 1. The most common organisms associated with hospital-acquired CRBSIs (in order of most to least common) are coagulase-negative Staphylococci, Staphylococcus aureus, Enterococci, and Candida. This can result in cellulitis, abscesses, or bacteremia and systemic infections. It also courses close to the brachial artery and median nerve, and therefore, it usually requires ultrasound guidance for access.Īs with any indwelling catheter in the body, there is always the risk of infection. The brachial vein is another option due to its larger size however, it is smaller and runs deeper than the basilic vein. PICCs placed through this vein are thought to have a higher incidence of mechanical phlebitis, and its sharp angle of insertion makes it difficult to advance the catheter. The cephalic vein is another option for PICC-line placement but, in addition to being smaller than the basilic vein, its course through the upper arm can be very tortuous. However, given its location in the antecubital fossa, constant bending at the elbow increase the risk of complications such as mechanical phlebitis. The median cubital vein usually offers the second best insertion site because it is prominent in the antecubital fossa and courses directly to the basilic vein and onward into the SVC. Other factors that have been thought to make the basilic vein the superior choice for PICC lines are that it has the least number of valves, better hemodilution capabilities and has a shallower angle of insertion compared to other veins. Additionally, it has the straightest route to its destination, as it courses through the axillary vein, then through the subclavian, and finally, settles in the SVC. The right basilic vein is the vein of choice due to its larger size and superficial location.

PICCs are placed through the basilic, brachial, cephalic, or medial cubital vein of the arm. They can be inserted centrally (centrally inserted venous catheter CICC) or peripherally (PICC). By definition, a central catheter is a venous access device that ultimately terminates in the superior vena cava (SVC) or right atrium (RA).

Triple lumen catheter french