Peripherally inserted central catheter

Last revised by Raymond Chieng on 10 Apr 2023

Peripherally inserted central catheters (PICCs), often incorrectly tautologically termed 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 catheter) or chest/brachial port.

  • central venous access required for long-term IV administration of medication (e.g. chemotherapy or antibiotics) or parenteral nutrition

  • peripheral access with standard IV cannulae is difficult or impossible

  • basilic and brachial veins are most commonly used; preprocedure ultrasound can be performed to identify an appropriately-sized vessel and ensure it is clot-free

  • sterile preparation and drape; ensure tourniquet is tight

  • subcutaneous infiltration of local anesthetic (e.g. lidocaine)

  • ultrasound-guided venous puncture followed by guidewire insertion; release the tourniquet

  • fluoroscopy to ensure guidewire position is venous

  • small skin incision at the 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 the peel-away sheath

  • flush, secure and dress PICC

  • fluoroscopic spot acquisition/chest x-ray in inspiration to document correct position

  • hemorrhage

  • arrhythmia

  • arterial puncture: less common with image guidance

  • malposition: less common with image guidance. Beware of anatomical variants such as a left SVC

  • allergic reaction 2

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Cases and figures

  • Case 1: PICC
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  •  Case 2: PICC malposition
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  • Case 3: PICC malpositioned in right IJV
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  • Case 4: correct position - left
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  • Case 5: malpositioned PICC line in IJV
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  • Case 6: PICC in azygos arch
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  • Case 7: left PICC in the right subclavian vein
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  • Case 8: bilateral PICCs
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  • Case 9: malpositioned PICC in IVC
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  • Case 10: fractured PICC
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  • Case 11: pulmonary embolization of PICC fibrin sheath
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