Peripherally inserted central venous catheter (PICC)
PICCs are thin, flexible plastic tubes with a diameter of 1 to 2 mm. The PICC is not sited centrally (like the CVC), but rather peripherally into the venous system (PICC = peripherally inserted central venous catheter).
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What are the advantages of a PICC?
PICCs have the advantage that they are relatively easy to implant and remove. They are primarily used for medium-term central venous therapy (1 to 3 months). Since the catheters are inserted peripherally, blood clotting does not play such a major role in the doctor’s decision. PICCs can be used for home-based treatment.
PICCs are suitable for taking blood as well as for administering medication. Special PICCs are also available for high-pressure injections (up to 4 ml/s and up to a pressure of 325 psi) of contrast medium used in CT or MRI scans.
How is a PICC sited?
PICCs are sited under local anaesthetic and using ultrasound and X-ray guidance. The superficial (vena basilica) or deep (vena brachialis) vein of the upper arm is punctured using a cannula and the catheter is then fed into the vein using a guide wire (this is known as the Seldinger technique). At the exit point on the upper arm just above the elbow, the catheter is secured in place with a special adhesive dressing (e.g. Statlock©) and covered with a sterile dressing.
How is a PICC looked after?
PICCs should be regularly flushed with 0.9 percent saline solution. The PICC’s adhesive dressing should be changed on a weekly basis. With the correct care and providing no complications occur, a PICC can also be left in situ for more than 3 months. With long-sleeved clothing, the PICC is normally invisible from the outside.
What are the risks of implantation?
Unlike other central venous catheters, a vein in the upper arm is punctured using ultrasound guidance for a PICC, rather than a central vein. Consequently, the complications associated with this procedure are far less, making the implantation very safe. This means that a PICC can be sited in critically ill patients or patients with poor clotting. The combination of ultrasound-guided venepuncture and fluoroscopy-guided (with X-rays) placement of the PICC means that the potential risks can be reduced even further.
Possible risks include bleeding and bruising, missed puncture of the brachial artery and puncture of a nerve. Over time there is also a risk of infection or the formation of an abscess, as well as thrombosis of the vein or catheter.
Bibliography
- O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011 May;39(4 Suppl 1):S1-34. doi: 10.1016/j.ajic.2011.01.003.
- O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.
- Moureau N. Vascular safety: it’s all about PICCs. Nurs Manage. 2006 May;37(5):22-7; quiz 50. Review.
- Gebauer B, Beck, Wagner HJ. Zentralvenöse Katheter: Diagnostik von Komplikationen und therapeutische Optionen. Radiologie up2date 2008; 8(2): 135-154 DOI: 10.1055/s-2007-995703