Can I Safely Discharge a Patient with a Substance Use Disorder Home with a Peripherally Inserted Central Catheter?

Amid the overdose crisis in the United States, serious injection-related infections, including endocarditis and skin and soft tissue infections, are rising.Determining where a patient goes after hospitalization can be a challenge due to the need for prolonged parenteral antibiotics, prompting the question: Can I safely discharge a patient with a substance use disorder home with a peripherally inserted central catheter (PICC)?In this article, the authors provide a review of existing evidence related to PICC utilization among people who use drugs in order to help answer this increasingly common clinical question. The epidemiology of the U.S. overdose crisis has evolved from oral ingestion of prescription opioids to injection of opioids (e.g., heroin and fentanyl) and increasingly includes stimulants. 1 As a result, the incidence of serious injection-related infections, including endocarditis and skin and soft tissue infections, is rising.2,3 As hospitalizations for these infections increase, 4 determining where the patient goes after hospitalization is an increasing challenge because of the need for prolonged parenteral antibiotics.5 Peripherally inserted central catheters (PICCs) are a requirement for most outpatient parenteral antibiotic therapy (OPAT) programs, but clinicians commonly avoid the use of PICCs for people who use drugs.6,7 This results in prolonged hospitalizations for people who use drugs, placing them at increased risk for hospital-related infections and increasing the likelihood of patient-directed discharges.8 Summarily avoiding PICC use among people who use drugs may strip patients of their autonomy in shared decision-making, compromise the standard of care, and further stigmatize drug use.Frontline clinicians often face this question: Can I safely discharge a patient with a substance use disorder home with a PICC?Herein, we provide a review of existing evidence related to PICC utilization among people who use drugs in order to help answer this increasingly common question.We have focused our review on three areas: evaluation of the potential complications of using PICC lines in people who use drugs, description of combined infection and substance use disorder treatment models, and discussion of risk assessment tools for PICC use in this patient population.