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PICC Thrombosis During OPAT — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionPICC Thrombosis During OPATSCE Infectious Diseases

A 50-year-old woman on long-term IV antibiotics via a PICC line for prosthetic joint infection develops a line-related thrombosis confirmed by Doppler ultrasound. The PJI treatment must continue for 4 more weeks. What is the most appropriate management?

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Correct answer: B — Anticoagulate (therapeutic LMWH or DOAC), remove the PICC line if feasible and re-site if IV access is still needed

PICC-related thrombosis is a common complication of long-term IV access. Management includes therapeutic anticoagulation and consideration of line removal. If ongoing IV access is needed (as in this case — 4 more weeks of IV PJI treatment), the line should be removed and re-sited in a different vein. Oral switch may be considered based on the OVIVA trial evidence for bone and joint infections, but this depends on the organism, bioavailability of oral alternatives, and timing in the treatment course. Anticoagulation duration is typically 3 months.

Reference: NICE NG158 2019 – VTE; BSAC 2019 – OPAT guidelines; OVIVA Trial