Question from C.F. 6/8/20
The answer to your question is yes, triple lumen PICCs DO have an increase in complications. There are studies to correlate increase risk associated with diameter size of the catheter and higher infection risk with manipulation of multiple lumen. While some companies have reduced the diameter of triple lumen PICCs in an effort to reduce incidence of thrombosis, clinicians find a subsequent increase in occlusion related to reduced inner lumen diameters. I am attaching a number of reference articles that support not only that there is an increase in complications, but also that we should only use dual or triple lumen catheters when there is a clear indication. Instead, using a single lumen as the default catheter is the best option for lowest incidence of complications and requiring selection of criteria to determine when more lumen are necessary. Limiting the number of lumen is a strategy to reduce thrombosis and infection with PICCs.
I hope this answers your question. Glad to help anytime.
Click to link to References:
- Baxi SM, Shuman EK, Scipione CA, et al. Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 2013;34(8):785-792.
- Bozaan D, Skicki D, Brancaccio A, et al. Less lumens-less risk: a pilot intervention to increase the use of single-lumen peripherally inserted central catheters. Journal of Hospital Medicine. 2018;14(1):42-46.
- Byrne D, Penwarden L. Selection of Single-Versus Double-Lumen Peripherally Inserted Central Catheters and the Influence on Alteplase Use. Journal of Infusion Nursing. 2018;41(2):118-121.
- Chopra V, Anand S, Krein S, Chenoweth C, Saint S. Bloodstream Infection, Venous Thrombosis, and Peripherally Inserted Central Catheters: Reappraising the Evidence. American Journal of Medicine. 2012;125(8):733-741.
- Chopra V, Flanders S, Saint S, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Annals of internal medicine. 2015;163(6 Suppl):S1-40.
- Dezfulian C, Lavelle J, Nallamothu B, Kaufman S, Saint S. Rates of infection for single-lumen versus multilumen central venous catheters: a meta-analysis. Critical care (London, England). 2003;31(9):2385-2390.
- Dobbins BM, Catton JA, Kite P, McMahon MJ, Wilcox MH. Each lumen is a potential source of central venous catheter-related bloodstream infection. Critical care medicine. 2003;31(6):1688-1690.
- Nifong T, McDevitt T. The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. Chest. 2011;140(1):140-153.
- Sharp R, Cummings M, Fielder A, Mikocka-Walus A, Grech C, Esterman A. The Catheter to Vein Ratio and Rates of Symptomatic Venous Thromboembolism in Patients with a Peripherally Inserted Central Catheter (PICC): A Prospective Cohort Study. International Journal of Nursing Studies. 2015;52(3):677-685.
- Sharp R, Grech C, Fielder A, Mikocka-Walus A, Esterman A. Vein diameter for peripherally inserted catheter insertion: a scoping review. The Journal of the Association for Vascular Access. 2016;21(3):166-175.
- Trerotola S, Stavropoulos S, Mondschein J, et al. Triple-Lumen Peripherally Inserted Central Catheter in Patients in Critical Care Unit: Prospective Evaluation. Radiology. 2010;256(1):312-20