Table S2. Definitions, diagnosis, ant treatment of PICC-related complications(see references below )

Complications / Definitions/evaluation / Diagnosis / Treatment
Inmediate complications (first 24 h) / Mechanical complications / Arterial puncture, pneumothorax, mediastinal haematoma, haemothorax. / Radiography and clinical evaluation. / Blood transfusion or surgery. Consider PICC removal.
Malposition / PICC requiring readjustment or reinsertion. / Radiography. / Reposition the PICC tip.
Late major complications / Bloodstream infection / Bacteriemia or fungemia in patients with intravascular device and > 1 positive blood cultures obtained from the peripheral vein, clinical manifestations of, and no apparent source for bloodstream infection.* / Blood cultures obtained from PICCs and peripheral blood. / Empirical antimicrobial therapy. Modify according to results of the blood cultures. Consider PICC removal.
Symptomatic PICC-related thrombosis / Limb pain or swelling. / Doppler ultrasound. ** / Anticoagulant therapy. Consider PICC removal.
Late minor complications / Phlebitis / Signs/symptoms of inflammation along a superficial vein. / Physical examination. / Extremity elevation, warm or cool compresses and topical diclofenac emulsion gel (associated or not to oral diclofenac 75 mg bid).
Exit-site infection / Signs/symptoms of inflammation within 2 cm of the PICC exit site. / Concomitant blood and exit-site cultures. / Topical antibiotic agents. PICC is left in place. If ineffective, administrate systemic antimicrobial therapy.
Catheter occlusion / Inability to flush, to infuse, and/or to aspirate from the catheter requiring the use of Urokinase to restore the patency of the PICC, at least once, during the period of time that the PICC was in place. / Linogram, if Urokinase is ineffective. / Thrombolytic therapy. ***
Mechanical disfunction / Inability to infuse through PICC due to tight suture, catheter tip positioned against vessel wall, precipitation of infused drugs or lipid residues. / Evaluate Huber needle placement. Radiography if pinch-off syndrome is suspected. Review medications and parenteral nutrition preparations. / Reposition the patient. Drug precipitate or lipid: cause-specific therapy. ****
Mechanical obstruction / Inability to flush, to infuse, and to aspirate through PICC due to kinking or dislodgement of catheters. / Radiography and/or Linogram, / Consider PICC removal,

*One of the following should be present: a positive result of semiquantitative or quantitative catheter culture, where by the same organism is isolated from a catheter segment and a peripheral blood culture; simultaneous quantitative cultures of blood with a ratio of >3:1 CFU/mL of blood (catheter vs. peripheral blood); or differential time to positivity. **Thrombosis of the subclavian, axillary, humeral, basilic and cephalic veins were included. ***Urokinase 10.000 units (Abbokinase Open-Cath; Abbott Pharmaceuticals, Abbot, IL). After 15 min, the solution will be aspirated for checking the catheter patency. If first attempt is ineffective (for total of 2 doses),leave second attempt of Urokinase indwelling up to 24 hours before proceeding with next steps in troubleshooting. **** Should be treated with sodium bicarbonate (1·0 mol/L) or sodium hydroxide (0·1 mol/L).

References

  1. Worth LJ, Seymour JF, Slavin MA (2009) Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Support Care Cancer 17:811–818.
  1. Harter C, Ostendorf T, Bach A, Egerer G, Goldschmidt H, Ho AD (2003) Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haematological malignancies. Support Care Cancer 11:790–794
  1. Leonard A. Mermel, Michael Allon, Emilio Bouza, Donald E. Craven, Patricia Flynn, Naomi P. O’Grady, Issam I. Raad, Bart J. A. Rijnders, Robert J. Sherertz, and David K. Warren, (2009). Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 49(1): 1–45. doi: 10.1086/599376.
  1. O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. (2002) Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 30(8):476–489.