Central IVs risky for severe morning sickness

By Megan Rauscher

NEW YORK (Reuters Health) - When a pregnant woman has severe morning sickness, known as hyperemesis, she may need fluids and medications. However, intravenous administration via a peripherally inserted central catheter (PICC) line should probably be avoided, a new study indicates.

A PICC line is a thin tube inserted into a vein, usually in the arm, and threaded into the vena cava, the large vein that enters the heart. It is usually used when prolonged IV treatment is needed.

In the current study, researchers found that PICC lines used for treating hyperemesis carry a very high risk of serious complications for the mother -- including bloodstream infections, sepsis and blood clots -- without significantly improving outcomes for the baby.

"Therefore, PICC line placement in pregnant patients with hyperemesis should only be used if absolutely necessary," Dr. Calla Holmgren from the University of Utah Health Sciences Center in Salt Lake City, told Reuters Health.

Nasogastric tubes for the administration of fluids and supplemental therapy "may be the more prudent therapy" to treat hyperemesis that doesn't improve with medication, she and her colleagues suggest in the American Journal of Obstetrics and Gynecology.

The team reviewed the outcomes of 94 pregnant women hospitalized with hyperemesis. "I initially considered the project because of the number of complications we were seeing with PICC lines in our pregnant patients with hyperemesis," Holmgren noted.

Of the 94 women, 33 had a PICC line inserted, 19 had a nasogastric tube placed, and 42 were managed with medication alone.

There were "striking differences" between the groups with regard to maternal complications, the investigators report.

Among the patients with PICC lines, two-thirds required treatment for infection, blood clot, or both. Compared with medical management, the likelihood of complications was almost 35 times higher with PICC lines and 7 time higher with nasogastric tubes.

There were no significant between-group differences in terms of the infants' outcomes for the three treatments evaluated.

"Any time a treatment strategy is considered during pregnancy, it is important to consider the risks of the treatment against the potential benefit, keeping in mind that there are two patients, mother and fetus," Holmgren said. "We conclude that the use of PICC lines for the management of hyperemesis gravidarum is rarely indicated and, except in specific circumstances, should be avoided."

SOURCE: American Journal of Obstetrics and Gynecology, January 2008.