Management of the complications of long-term venous access.

The increasing use of permanent venous access devices and peripherally inserted central catheters has dramatically altered how we care for patients with a variety of illnesses. The development of complications either at the time of catheter insertion or with prolonged use may result in limited durability of the device, decreased cost-effectiveness, and significant patient morbidity or mortality. Our purpose is to review for the clinician the common complications associated with permanent venous access devices (PVADs) and peripherally inserted central catheters (PICCs). Most PVAD complications occurring at the time of catheter insertion can be avoided by returning to the venous cut-down technique. The most common cause for PVAD removal before the completion of therapy is catheter-related infection, whereas mechanical device failures result in most premature removals of PICCs. Catheter-related subclavian and axillary vein thromboses are not benign but are associated with up to a 12% incidence of pulmonary embolism. Future prospective investigations are needed to identify techniques to prevent, or better manage, the major long-term complications of PVADs and PICCs.