Peripherally inserted central catheter
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A peripherally inserted central catheter (PICC or PICC line), less commonly called a percutaneous indwelling central catheter, is a form of
First described in 1975,
Medical uses
Generally, PICC lines are considered when a person is expected to need more than two weeks of intravenous therapy.[2] A PICC line can remain inserted for an extended period of time compared to other forms of central IV access, ranging from seven days up to several months as long as the line remains viable.[3] They are utilized in both the hospital and community settings. They are commonly used in people receiving total parenteral nutrition (TPN), chemotherapy, or long term medications such as antibiotics. They may also be used to obtain a blood sample if the lumen is of sufficient size (at least 4 French gauge).
To help prevent the line from becoming clogged, the line should be regularly flushed with normal saline, and "locked" by filling it with
Contraindications
A PICC line may not be inserted in a part of the body which is burned or has a local infection. Damage to the skin and surrounding tissue from radiation may also prevent the placement of a PICC line.[4]
Risks and complications
As with any intravenous line, there is the risk for
Other complications may include catheter occlusion,
Technique
A PICC is inserted in a
Selection of vein and catheter
A PICC line is an invasive medical procedure, and may require local or general anesthesia during the placement. The
Insertion
While an operating room is not required for the insertion of a PICC line, it is important to maintain a sterile environment surrounding the insertion site. This involves cleaning the skin around the site, as well as the use of a sterile gown, gloves, and drape to reduce the risk of environmental contamination. After the skin is prepared, an incision is made and a device called an "introducer" is inserted into the vein. The catheter is cut to the desired length if required, and filled with saline for the duration of the insertion. The PICC line is inserted via the introducer device, and threaded through the veins to the desired end location.[5] Fluoroscopy or echocardiographic guidance may be used to monitor the tip position during insertion.
Removal
In most cases the removal of a PICC is a simple procedure. Generally, the catheter line can be safely and quickly removed by a trained nurse, even in the patient's own home, in a matter of minutes. After removal, the insertion site is normally bandaged with sterile gauze and kept dry for a few days, during which the wound can close and begin healing. Usually, a smaller adhesive bandage can be placed over the wound site after the gauze is removed if the wound is slow to heal. The tip of the catheter is sent for microscopy culture and sensitivity (MCS) if the patient is systemically unwell at the time of removal of the PICC. In certain units, it is sent as routine investigation.
See also
References
- PMID 805577.
- ^ PMID 26369828.
- ^ "Guidelines for the Prevention of Intravascular Catheter-Related Infections". Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Retrieved July 23, 2019.
- S2CID 10458652.
- ^ PMID 24440542.
- Centre for Disease Control
- ^ "Safety of Catheter Lock with or Without Heparin in Implanted Central Venous Catheters - Related Studies - ClinicalTrials.gov". Archived from the original on August 1, 2013. Retrieved February 5, 2012.
- ^ U Wisconsin, Preparing and Caring Archived August 4, 2013, at the Wayback Machine, accessed July 24, 2013
Further reading
- Bender, C. M., Rosenzweig, M., & Green, E. (2006). "Cancer". In S. Goldsworthy & M. A. Barry. Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems (1st Canadian ed.). Mosby: Toronto. ISBN 0-7796-9969-6.