Peripherally inserted central catheter

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.

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 cannulae is difficult or impossible

Technique

• 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

Complications

Periprocedural

• 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

Late

• line fracture/embolization or accidental withdrawal

• formation of fibrin sheath

• infection, e.g. catheter- or wound-related (most common) ³

• tip migration

• deep vein thrombosis ²