Peripherally revealed occlusion being the most common complications.

Peripherally inserted central venous catheter
(PICCs) are widely used nowadays in providing intermediate and long term venous
access in hospital, namely for long term administration of antibiotics,
parenteral nutrition and chemotherapy. Being a less invasive alternative of
central venous access give rise to its popularity over conventional central
venous catheters (CVCs)


They are however, not without associated
risks and complications. Among the common risks and complications related to
PICCs are phlebitis, thrombosis, premature dislodgement, malfunction and
central line-associated blood stream infection (CLABSI).  A study by Carlson in 2003 showed up to
one-third of PICCs removed as a result of a complication. A more recent study
by Delphine Grau et at in 2017 showed similar rate of 30.2% out of 163 catheters with a mean time to onset of
16.1 days. While Carlson reported the most common reason was
infection, Delphine Grau revealed occlusion being the most common
complications. Both reported similar rate of infection as 7.4% and 6.3%
respectively. Other complications
reported by Delphine Grau also include accidental withdrawal (8.9%), venous
thrombosis (1.6%) and hematoma (1%) (1). The implication of these
risks is increase cost for patient management results from prolonged lengths of
health care stay. The reported increased costs ranges from $3,700 to $29,000
per episode (2-4)
and a total yearly cost of $300 million to $2 billion for all U.S health care
facilities (5).


Most of the studies only compared CLABSI rate
between conventional CVC and tunneled CVC, CVC and conventional PICC or between
different types of conventional PICCs (6). While we have learnt from studies
done by Norazak et al at University Malaya Medical Centre (UMMC) in 2013 that
tunneled PICCs have a lower rate of blood stream infection (BSI) compared to
conventional PICCs (7), we continue to strive for
catheter factors and technique of catheter insertion which could potentially
minimize the rate of BSI. Among the new PICCs 
are cuffed (medicated or non medicated impregnation – discussed later) PICCs which are
designed with the aim to minimize the risk of both local and bloodstream
infection. With this study we hope to determine if cuff can reduce infection
rate in PICC by comparing blood stream infection rate between tunneled cuffed
PICC and tunneled non cuffed PICC. We also hope to compare the
catheter-days and time to infection between these two methods, and also to look
at other catheter related complications such as local infection, catheter
blockage and dislodgement.