Peripherally inserted central catheter

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Correct position of PICC line on chest x-ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

A peripherally inserted central catheter (PICC or PIC line) is a form of intravenous access that can be used for a prolonged period of time, e.g. for long chemotherapy regimens, extended antibiotic therapy or total parenteral nutrition. First described in 1975,[1] it is an alternative to subclavian lines, internal jugular lines or femoral lines which have higher rates of infection. Subclavian and internal jugular line placements may result in pneumothorax (air in the pleural space of lung).

A PICC is inserted in a peripheral vein, such as the cephalic vein, basilic vein, or brachial vein and then advanced through increasingly larger veins, toward the heart until the tip rests in the distal superior vena cava or cavo-atrial junction.

PICCs are usually inserted by radiologists, physician assistants, radiologist assistants, or certified registered nurses using ultrasound, chest radiographs and fluoroscopy to aid in their insertion and to confirm placement. Complications may include catheter occlusion, phlebitis, hemorrhage, thrombosis and infection. Urokinase may be used to lyse obstructions. PICC lines generally will remain in place no longer than 30 days, although duration of use varies from just a few days in patients requiring short courses of chemotherapy or biotherapy to a year for patients requiring longer treatment. Commonly, other forms of intravenous access are considered if the treatment course is protracted. While replacement is generally considered a year post-insertion, patients have survived with the same PICC in situ for several years without complication.

Certain types of PICCs have recently been approved by the FDA for use in power injection. These PICCs, often referred to as "POWER PICCs", are designed to withstand the high pressures associated with radiocontrast studies.

Notes

  1. Hoshal VL. Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters. Arch Surg 1975;43:1937–43. PMID 805577.

References

  • 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 0779699696.

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