Should ultrasound evaluation for catheter-related thrombosis always be required before PICC removal?

Abstract

Despite several effective preventive strategies peripherally inserted central catheters (PICCs)—as much as centrally inserted central catheters and femorally inserted central catheters—are inevitably associated with the potential development of catheter-related thrombosis. This complication may be symptomatic or—more often—asymptomatic. Even if remote, the chance that PICC removal may mobilize an asymptomatic thrombus and cause pulmonary embolism, is theoretically possible. On the other hand, the diffuse adoption of an ultrasound scan aiming at detecting an asymptomatic catheter-related thrombosis may be logistically difficult and expensive. No clear evidence-based recommendations exist on this issue and whether perform an ultrasound scan before PICC removal in asymptomatic patients remains a matter of debate. For these reasons, the authors propose few common sense recommendations that may help clinicians in weighing the clinical advantages of the exam (optimal safety for the patient) versus its practical disadvantages (logistic cost).