Power-injectable peripherally inserted central catheters: a step-down access or a real alternative to standard central venous lines?

e recent article by Pittiruti and colleagues reports important clinical experience with power-injectable peripherally inserted central catheters (P-PICCs) in critically ill patients [1]. Nevertheless, I believe some of the fi ndings deserve clarifi cation. Th e authors argue that an advantage of P-PICCs is the possibility to deliver a faster infusion of fl uids and/or drugs to critically ill patients. Since P-PICCs were not inserted during emergencies and in severe sepsis, however, the benefi t of allowing high fl ow rates is limited to patients that develop haemodynamic distress after catheter placement. Th e advantage of allowing infusion of contrast media, although important, is no diff erent from other peripheral noncentral venous devices. To help understand the role of P-PICCs and to compare complication rates with standard central lines (central venous catheters), it would therefore be interesting to know the severity of illness of patients that eventually received P-PICCs and the percentage of patients that had P-PICCs as their solo central line during their ICU stay. Th e time interval between admission to the ICU and P-PICC placement would also be interesting data, since the high dwell time reported by the authors suggests that P-PICCs were probably preferentially inserted in patients with pro longed critical illness. If most P-PICCs were inserted in stable chronic patients, the advantage of P-PICCs over conventional peripherally inserted central catheters (PICCs) would be limited in real-life clinical practice. In addition to comparing P-PICCs with central venous catheters, as suggested by the authors, perhaps further research should also focus on evaluating the role of the P-PICC as a step-down vascular access for stable critically ill patients.