Complicações do PICC em adultos: prevenção e estratégias de enfermagem baseadas em evidências
DOI:
https://doi.org/10.33159/25959484.repen.2026v37a04Palavras-chave:
PICC, Complicações, Enfermagem, Trombose, InfecçãoResumo
Objetivo: Analisar as principais complicações relacionadas ao uso do Cateter Central de Inserção Periférica (PICC) em adultos, com ênfase em infecções da corrente sanguínea, trombose venosa e obstrução do lúmen, além de identificar estratégias de prevenção com foco na atuação da enfermagem. Métodos: Para isso, foi realizada uma revisão integrativa da literatura, contemplando publicações dos últimos dez anos que abordaram fatores clínicos, técnicos e organizacionais associados ao uso do PICC. Os estudos incluídos consideraram práticas de enfermagem, protocolos assistenciais e o uso de tecnologias como a ultrassonografia. Resultados: A análise demonstrou que a adoção de práticas baseadas em evidências, a capacitação contínua da equipe de enfermagem e a padronização de protocolos contribuem significativamente para a prevenção de complicações. A correta inserção, manutenção e monitoramento do PICC estão associados à redução expressiva dos riscos de infecção, trombose e obstrução, promovendo maior segurança e eficácia nos tratamentos intravenosos de longa duração. Conclusão: Conclui-se que o PICC é uma alternativa segura e eficaz para o acesso venoso em pacientes adultos, desde que bem indicado e gerenciado. A atuação da enfermagem é essencial para minimizar riscos e garantir a qualidade do cuidado, especialmente em contextos clínicos complexos, nos quais a personalização da assistência e o uso de tecnologias desempenham um papel central.
Referências
1. Waitt C, Waitt P, Pirmohamed M. Intravenous therapy. Postgrad Med J. 2004;80(939):1–6. https://doi.org/10.1136/pmj.2003.010421
2. Merrell SW, Peatross BG, Grossman MD, Sullivan JJ, Harker WG. Peripherally inserted central venous catheters: Low-risk alternatives for ongoing venous access. West J Med [Internet]. 1994[cited 2025 Jun 30];160(1):25–30. Available from: https://pubmed.ncbi.nlm.nih.gov/8128698/
3. Sharp R, Grech C, Fielder A, Mikocka Walus A, Esterman A. Vein diameter for peripherally inserted catheter insertion: a scoping review. J Assoc Vasc Access. 2016;21(3):166–75. https://doi.org/10.1016/j.java.2016.02.002
4. Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature. Acta Oncol. 2013;52(5):886–92. https://doi.org/10.3109/0284186X.2013.773072
5. Moureau N. Vascular safety: it’s all about PICCs. Nurs Manage. 2006;37(5):22–27. https://doi.org/10.1097/00006247-200605000-00007
6. Nicholson J. Development of an ultrasound-guided PICC insertion service. Br J Nurs. 2010;19(10):S9–17. https://doi.org/10.12968/bjon.2010.19.Sup3.48212
7. Von Eiff C, Jansen B, Kohnen W, Becker K. Infections associated with medical devices: Pathogenesis, management, and prophylaxis. Drugs. 2005;65(2):179–214. https://doi.org/10.2165/00003495-200565020-00003
8. Pelling H, Nzakizwanayo J, Milo S, Denham EL, Macfarlane WM, Bock LJ, et al. Bacterial biofilm formation on indwelling urethral catheters. Lett Appl Microbiol. 2019;68(4):277–93. https://doi.org/10.1111/lam.13144
9. Busch LM, Kadri SS. Antimicrobial treatment duration in sepsis and serious infections. J Infect Dis. 2020;222(Suppl 2):S142–55. https://doi.org/10.1093/infdis/jiaa247
10. Ahmed SS, McCaskey MS, Bringman S, Eigen H. Catheter-associated bloodstream infection in the pediatric intensive care unit: a multidisciplinary approach. Pediatr Crit Care Med. 2012;13(2):e69–72. https://doi.org/10.1097/PCC.0b013e31820ac2e1
11. Zochios V, Umar I, Simpson N, Jones N. Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access. 2014;15(5):329–37. https://doi.org/10.5301/jva.5000239
12. Dougherty L. Frequency, diagnosis, and management of occlusive and mechanical PICC complications. In: Peripherally inserted central venous catheters. Milano: Springer Milan; 2014. p. 85–94. https://doi.org/10.1007/978-88-470-5665-7_8
13. Pina TV, Cunha NC, Ferreira EB, Rocha PRS. Complications of peripherally inserted central catheter: integrative review. Rev Enferm UFPE. 2023;17(1). https://doi.org/10.5205/1981-8963.2023.253981
14. Oliveira RM, Leitão IMTA, Silva LMSD, Figueiredo SV, Sampaio RL, Gondim MM. Strategies for promoting patient safety: from the identification of the risks to evidence-based practices. Esc Anna Nery. 2014;18:122–9. https://doi.org/10.5935/1414-8145.20140018
15. Xu B, Zhang J, Hou J, Ma M, Gong Z, Tang S. Nurses’ attitudes and knowledge of peripherally inserted central catheter maintenance in primary hospitals in China: a cross-sectional survey. Risk Manag Healthc Policy. 2020;13:903–13. https://doi.org/10.2147/RMHP.S250741
16. Aljanabi HM, Mousa O, Al Zawad MA, Sindi FR, Asalem RA, Alqasim AA, et al. Evaluating the knowledge and attitudes of nurses toward PICC care before and after specialized training in Dammam Health Network (DHN) in the KSA. Gland Surg. 2024;9(2):481–516. https://doi.org/10.13140/RG.2.2.23971.57129
17. Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med. 2006;31(4):311–23. https://doi.org/10.1016/j.rapm.2006.04.004
18. Mendes KDS, Silveira RCDCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17:758-64. https://doi.org/10.1590/S0104-07072008000400018
19. Oliveira JLR, Beccaria LM, Pereira GAA, Poletti NA, Gabriel CS. Cateter central de inserção periférica em adultos hospitalizados: competências necessárias à sua inserção. Rev Bras Enferm. 2020;73(Supl. 4):e20190240. https://doi.org/10.1590/0034-7167-2019-0240
20. Pereira FG, Oliveira AC, Paula AO, Souza RM. (). Infraestrutura hospitalar e segurança do paciente: uma análise a partir das boas práticas em terapia intravenosa. Rev Bras Enferm. 2019;72(6):1562–8. https://doi.org/10.1590/0034-7167-2018-0680
21. Walters B, Price C. Quality improvement initiative reduces the occurrence of complications in peripherally inserted central catheters. J Infus Nurs. 2019;42(1):29–36. https://doi.org/10.1097/NAN.0000000000000310
22. Meyer BM. Understanding the patient experience of peripherally inserted central catheter-related deep vein thrombosis using interpretive phenomenology. J Infus Nurs. 2017;40(5):287-96. https://doi.org/10.1097/nan.0000000000000238
23. 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. Int J Nurs Stud. 2015;52(3):677–85. https://doi.org/10.1016/j.ijnurstu.2014.12.002
24. Chang C, Zhang H, Wang Y, Liu F, Li Y. Prognostic factors for catheter-related thrombosis in hematological patients with peripherally inserted central catheters. Thromb Res. 2025;223:105507. https://doi.org/10.1097/MD.0000000000041181
25. Santacruz Cerdá E, Arcano K, Arrieta Blanco F, Ortiz Flores A, Mateo Lobo R, Botella Carretero JI, et al. Eficacia de la nutrición parenteral domiciliaria de larga evolución con catéter de acceso periférico: a propósito de un caso. Nutr Hosp. 2016;33(1):185–7. https://doi.org/10.20960/nh.31
26. Alsaleh K, Alosaimi D, Almousawi A, Alshaikh M, Omar H. Effectiveness of a nurse-led peripherally inserted central catheter service: a retrospective cohort study. J Vasc Access. 2024;26(4). https://doi.org/10.1177/11297298241263886
27. Assis GLC, Mota ANB, Cesar VF, Turrini RNT, Ferreira LM. Custo direto da inserção do cateter central de inserção periférica por enfermeiros em adultos hospitalizados. Rev Bras Enferm. 2021;74:e20190663. https://doi.org/10.1590/0034-7167-2019-0663
28. Mitelmão FCR, Mangini Filho S, Chaud MV, Vila MMDC, Balcão VMCF, Oliveira Junior JMD. Caracterização física de cateteres centrais de inserção periférica (CCIP). Matéria (Rio J). 2020;25:e-12545. https://doi.org/10.1590/S1517-707620200001.0870
29. Lv L, Wang H, Zhang X, Zhang M. Cluster nursing in the prevention of PICC related venous thrombosis and its influence on tumor patients' coagulation functions. Int J Clin Exp Med [Internet]. 2020[cited 2025 Jun 30];13(12):10005–11. Available from: https://e-century.us/files/ijcem/13/12/ijcem0120598.pdf
30. Huang R, Jiang Y, Le X. [Retracted] Prevention and nursing research of PICC catheter related complications in patients with digestive system malignant tumors based on smart medical blockchain. J Healthc Eng. 2021;2021(1):5519722. https://doi.org/10.1155/2021/5519722
31. McDiarmid S, Scrivens N, Carrier M, Sabri E, Toye B, Huebsch L, et al. Outcomes in a nurse led peripherally inserted central catheter program: a retrospective cohort study. CMAJ Open. 2017;5(3):E535–9. https://doi.org/10.9778/cmajo.20170010
32. Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer. 2020;28:4753–60. https://doi.org/10.1007/s00520-019-05276-0
33. Grau D, Clarivet B, Lotthé A, Bommart S, Parer S. Complications with peripherally inserted central catheters (PICC) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control. 2017;6:1–8. https://doi.org/10.1186/s13756-016-0161-0
34. Curto García N, García Suárez J, Callejas Chavarria M, Gil Fernández JJ, Martín Guerrero Y, Magro Mazo E, et al. A team based multidisciplinary approach to managing peripherally inserted central catheter complications in high risk haematological patients: a prospective study. Support Care Cancer. 2015;24:93–101. https://doi.org/10.1007/s00520-015-2754-1
35. Ullman AJ, August D, Kleidon T, Walker R, Marsh NM, Bulmer A, et al. Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomized controlled trial protocol. BMJ Open. 2021;11(4):e042475. https://doi.org/10.1136/bmjopen-2020-042475
36. Zheng LY, Peng Y, Yuan H, Liu SX, Xue H, Zhang XY. Nurses’ knowledge of the management of drug induced peripherally inserted central catheter obstruction: a descriptive phenomenological study. J Vasc Access. 2020;21(5):680–6. https://doi.org/10.1177/1129729819900864
37. Morano SG, Latagliata R, Girmenia C, Massaro F, Berneschi P, Guerriero A, et al. Catheter associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters (PICC). Support Care Cancer. 2015;23:3289–95. https://doi.org/10.1007/s00520-015-2740-7
38. Tolera BD, Hui F. Exploring individual and organizational factors influencing registered nurses in preventing peripherally inserted central catheter-related complications. J Nurs Pract. 2025;4(4). https://doi.org/10.5281/zenodo.546199
1. Waitt C, Waitt P, Pirmohamed M. Intravenous therapy. Postgrad Med J. 2004;80(939):1–6. https://doi.org/10.1136/pmj.2003.010421
2. Merrell SW, Peatross BG, Grossman MD, Sullivan JJ, Harker WG. Peripherally inserted central venous catheters: Low-risk alternatives for ongoing venous access. West J Med [Internet]. 1994[cited 2025 Jun 30];160(1):25–30. Available from: https://pubmed.ncbi.nlm.nih.gov/8128698/
3. Sharp R, Grech C, Fielder A, Mikocka Walus A, Esterman A. Vein diameter for peripherally inserted catheter insertion: a scoping review. J Assoc Vasc Access. 2016;21(3):166–75. https://doi.org/10.1016/j.java.2016.02.002
4. Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature. Acta Oncol. 2013;52(5):886–92. https://doi.org/10.3109/0284186X.2013.773072
5. Moureau N. Vascular safety: it’s all about PICCs. Nurs Manage. 2006;37(5):22–27. https://doi.org/10.1097/00006247-200605000-00007
6. Nicholson J. Development of an ultrasound-guided PICC insertion service. Br J Nurs. 2010;19(10):S9–17. https://doi.org/10.12968/bjon.2010.19.Sup3.48212
7. Von Eiff C, Jansen B, Kohnen W, Becker K. Infections associated with medical devices: Pathogenesis, management, and prophylaxis. Drugs. 2005;65(2):179–214. https://doi.org/10.2165/00003495-200565020-00003
8. Pelling H, Nzakizwanayo J, Milo S, Denham EL, Macfarlane WM, Bock LJ, et al. Bacterial biofilm formation on indwelling urethral catheters. Lett Appl Microbiol. 2019;68(4):277–93. https://doi.org/10.1111/lam.13144
9. Busch LM, Kadri SS. Antimicrobial treatment duration in sepsis and serious infections. J Infect Dis. 2020;222(Suppl 2):S142–55. https://doi.org/10.1093/infdis/jiaa247
10. Ahmed SS, McCaskey MS, Bringman S, Eigen H. Catheter-associated bloodstream infection in the pediatric intensive care unit: a multidisciplinary approach. Pediatr Crit Care Med. 2012;13(2):e69–72. https://doi.org/10.1097/PCC.0b013e31820ac2e1
11. Zochios V, Umar I, Simpson N, Jones N. Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access. 2014;15(5):329–37. https://doi.org/10.5301/jva.5000239
12. Dougherty L. Frequency, diagnosis, and management of occlusive and mechanical PICC complications. In: Peripherally inserted central venous catheters. Milano: Springer Milan; 2014. p. 85–94. https://doi.org/10.1007/978-88-470-5665-7_8
13. Pina TV, Cunha NC, Ferreira EB, Rocha PRS. Complications of peripherally inserted central catheter: integrative review. Rev Enferm UFPE. 2023;17(1). https://doi.org/10.5205/1981-8963.2023.253981
14. Oliveira RM, Leitão IMTA, Silva LMSD, Figueiredo SV, Sampaio RL, Gondim MM. Strategies for promoting patient safety: from the identification of the risks to evidence-based practices. Esc Anna Nery. 2014;18:122–9. https://doi.org/10.5935/1414-8145.20140018
15. Xu B, Zhang J, Hou J, Ma M, Gong Z, Tang S. Nurses’ attitudes and knowledge of peripherally inserted central catheter maintenance in primary hospitals in China: a cross-sectional survey. Risk Manag Healthc Policy. 2020;13:903–13. https://doi.org/10.2147/RMHP.S250741
16. Aljanabi HM, Mousa O, Al Zawad MA, Sindi FR, Asalem RA, Alqasim AA, et al. Evaluating the knowledge and attitudes of nurses toward PICC care before and after specialized training in Dammam Health Network (DHN) in the KSA. Gland Surg. 2024;9(2):481–516. https://doi.org/10.13140/RG.2.2.23971.57129
17. Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med. 2006;31(4):311–23. https://doi.org/10.1016/j.rapm.2006.04.004
18. Mendes KDS, Silveira RCDCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17:758-64. https://doi.org/10.1590/S0104-07072008000400018
19. Oliveira JLR, Beccaria LM, Pereira GAA, Poletti NA, Gabriel CS. Cateter central de inserção periférica em adultos hospitalizados: competências necessárias à sua inserção. Rev Bras Enferm. 2020;73(Supl. 4):e20190240. https://doi.org/10.1590/0034-7167-2019-0240
20. Pereira FG, Oliveira AC, Paula AO, Souza RM. (). Infraestrutura hospitalar e segurança do paciente: uma análise a partir das boas práticas em terapia intravenosa. Rev Bras Enferm. 2019;72(6):1562–8. https://doi.org/10.1590/0034-7167-2018-0680
21. Walters B, Price C. Quality improvement initiative reduces the occurrence of complications in peripherally inserted central catheters. J Infus Nurs. 2019;42(1):29–36. https://doi.org/10.1097/NAN.0000000000000310
22. Meyer BM. Understanding the patient experience of peripherally inserted central catheter-related deep vein thrombosis using interpretive phenomenology. J Infus Nurs. 2017;40(5):287-96. https://doi.org/10.1097/nan.0000000000000238
23. 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. Int J Nurs Stud. 2015;52(3):677–85. https://doi.org/10.1016/j.ijnurstu.2014.12.002
24. Chang C, Zhang H, Wang Y, Liu F, Li Y. Prognostic factors for catheter-related thrombosis in hematological patients with peripherally inserted central catheters. Thromb Res. 2025;223:105507. https://doi.org/10.1097/MD.0000000000041181
25. Santacruz Cerdá E, Arcano K, Arrieta Blanco F, Ortiz Flores A, Mateo Lobo R, Botella Carretero JI, et al. Eficacia de la nutrición parenteral domiciliaria de larga evolución con catéter de acceso periférico: a propósito de un caso. Nutr Hosp. 2016;33(1):185–7. https://doi.org/10.20960/nh.31
26. Alsaleh K, Alosaimi D, Almousawi A, Alshaikh M, Omar H. Effectiveness of a nurse-led peripherally inserted central catheter service: a retrospective cohort study. J Vasc Access. 2024;26(4). https://doi.org/10.1177/11297298241263886
27. Assis GLC, Mota ANB, Cesar VF, Turrini RNT, Ferreira LM. Custo direto da inserção do cateter central de inserção periférica por enfermeiros em adultos hospitalizados. Rev Bras Enferm. 2021;74:e20190663. https://doi.org/10.1590/0034-7167-2019-0663
28. Mitelmão FCR, Mangini Filho S, Chaud MV, Vila MMDC, Balcão VMCF, Oliveira Junior JMD. Caracterização física de cateteres centrais de inserção periférica (CCIP). Matéria (Rio J). 2020;25:e-12545. https://doi.org/10.1590/S1517-707620200001.0870
29. Lv L, Wang H, Zhang X, Zhang M. Cluster nursing in the prevention of PICC related venous thrombosis and its influence on tumor patients' coagulation functions. Int J Clin Exp Med [Internet]. 2020[cited 2025 Jun 30];13(12):10005–11. Available from: https://e-century.us/files/ijcem/13/12/ijcem0120598.pdf
30. Huang R, Jiang Y, Le X. [Retracted] Prevention and nursing research of PICC catheter related complications in patients with digestive system malignant tumors based on smart medical blockchain. J Healthc Eng. 2021;2021(1):5519722. https://doi.org/10.1155/2021/5519722
31. McDiarmid S, Scrivens N, Carrier M, Sabri E, Toye B, Huebsch L, et al. Outcomes in a nurse led peripherally inserted central catheter program: a retrospective cohort study. CMAJ Open. 2017;5(3):E535–9. https://doi.org/10.9778/cmajo.20170010
32. Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer. 2020;28:4753–60. https://doi.org/10.1007/s00520-019-05276-0
33. Grau D, Clarivet B, Lotthé A, Bommart S, Parer S. Complications with peripherally inserted central catheters (PICC) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control. 2017;6:1–8. https://doi.org/10.1186/s13756-016-0161-0
34. Curto García N, García Suárez J, Callejas Chavarria M, Gil Fernández JJ, Martín Guerrero Y, Magro Mazo E, et al. A team based multidisciplinary approach to managing peripherally inserted central catheter complications in high risk haematological patients: a prospective study. Support Care Cancer. 2015;24:93–101. https://doi.org/10.1007/s00520-015-2754-1
35. Ullman AJ, August D, Kleidon T, Walker R, Marsh NM, Bulmer A, et al. Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomized controlled trial protocol. BMJ Open. 2021;11(4):e042475. https://doi.org/10.1136/bmjopen-2020-042475
36. Zheng LY, Peng Y, Yuan H, Liu SX, Xue H, Zhang XY. Nurses’ knowledge of the management of drug induced peripherally inserted central catheter obstruction: a descriptive phenomenological study. J Vasc Access. 2020;21(5):680–6. https://doi.org/10.1177/1129729819900864
37. Morano SG, Latagliata R, Girmenia C, Massaro F, Berneschi P, Guerriero A, et al. Catheter associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters (PICC). Support Care Cancer. 2015;23:3289–95. https://doi.org/10.1007/s00520-015-2740-7
38. Tolera BD, Hui F. Exploring individual and organizational factors influencing registered nurses in preventing peripherally inserted central catheter-related complications. J Nurs Pract. 2025;4(4). https://doi.org/10.5281/zenodo.546199
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