Peripherally inserted central catheter
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Peripherally inserted central catheters (PICC), often called PICC lines, are a type of central venous catheter predominantly used amongst oncology patients and those with chronic diseases (e.g. cystic fibrosis).
They offer the ability to have long term central venous access without the need to have a surgically or radiologically inserted tunneled central venous catheter (e.g. Hickman's catheter) or chest/brachial port.
Indications
- central venous access required for long-term IV administration of medication (e.g. chemotherapy or antibiotics) or parenteral nutrition
- peripheral access with standard IV canullas is difficult or impossible
Technique
- basilic, brachial or cephalic veins are most commonly used; pre-procedure ultrasound can be performed to identify an appropriate sized vessel and ensure it is clot-free
- sterile preparation and drape; ensure tourniquet is tight
- subcutaneous infiltration of local anaesthetic (e.g. lignocaine/lidocaine)
- ultrasound-guided venous puncture followed by guidewire insertion; release tourniquet
- fluoroscopy to ensure guidewire position is venous
- small skin incision at puncture site
- exchange puncture needle for peel-away sheath
- removal of guidewire and insertion of PICC under fluoroscopic guidance to ensure tip is in an appropriate position (varies from institution-to-institution)
- removal of peel-away sheath
- flush, secure and dress PICC
- fluoroscopic spot acquisition/chest x-ray in inspiration to document correct position
Complications
- infection, e.g. catheter or wound related (most common) 3
- tip migration
- deep vein thrombosis
- peri-procedural
- haemorrhage
- arrhythmia
- arterial puncture: less common with image-guidance
- malposition: less common with image-guidance
- beware of anatomical variants such as a left SVC
- line fracture/embolisation or accidental withdrawal
-<li>malposition: less common with image-guidance</li>- +<li>malposition: less common with image-guidance<ul><li>beware of anatomical variants such as a <a title="Left SVC" href="/articles/left-sided-superior-vena-cava-1">left SVC</a>
- +</li></ul>
- +</li>