Peripherally inserted central catheter
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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).
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[edit] Insertion
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 cavoatrial junction.
PICCs are usually inserted by physicians, physician assistants (in the USA), radiologist assistants (in the USA), nurse practitioners, or specially trained certified registered nurses and radiologic technologists using ultrasound, chest radiographs, and fluoroscopy to aid in their insertion and to confirm placement. PICC insertion is a sterile procedure, but does not require the use of an operating room. When done at bedside (that is, in the patient's room), a suitable sterile field must be established and maintained throughout the procedure. For this reason, visitors are normally requested to leave the room until the insertion is complete and some form of skin preparation should be used to clean patient skin.
The insertable portion of a PICC varies from 25 to 60 centimeters in length, that being adequate to reach the desired tip position in most patients. Some lines are designed to be trimmed to the desired length before insertion, others are simply inserted to the needed depth with the excess left outside. As supplied, the line has a guide wire inside. This wire is provided to stiffen the (otherwise very flexible) line so it can be threaded through the veins. The wire is removed and discarded after insertion.
The PICC is also provided with a "wing" having holes for either sutures or an adhesive securement device such as Statlock. Other new technologies which may provide advantages are being introduced to the market such as the SecurAcath subcutaneous securement technology. Securing the catheter prevents post-insertion movement of the line, as that could place the tip in an unsafe position.
[edit] Usage
PICCs 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.[citation needed] Complications may include catheter occlusion, phlebitis, haemorrhage, thrombosis and infection. Urokinase or low dose tPA (AKA: Alteplase or Cathflo (Genentech, Inc) may be used to lyse obstructions.
Certain types of PICCs have recently been approved by the FDA for use in power injection. These PICCs, often referred to as power injectable PICCs, are designed to withstand the high pressures associated with radiocontrast studies.
PICCs can also be used to measure the CVP (Central Venous Pressure). CVP is a rough estimate of the right atrial pressures of the heart and can give valuable information about fluid status of the patient.
[edit] Removal
Removal of a PICC line is a considerably more simple procedure in most cases. 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.
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[edit] 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 0779699696.
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