Peripherally inserted central catheters

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.

  • central venous access required for long-term IV administration of medication (e.g. chemotherapy or antibiotics) or parenteral nutrition
  • peripheral access with standard IV cannulas is difficult or impossible
  • basilic, brachial or cephalic veins are most commonly used; pre-procedure 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 anaesthetic (e.g. lignocaine/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
  • 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
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Article information

rID: 6445
Synonyms or Alternate Spellings:
  • Peripherally inserted central catheters
  • Peripherally inserted central catheters (PICC)
  • PICC lines
  • Peripherally inserted central catheter

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Cases and figures

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    PICC line
    Case 1: PICC
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     Case 2: PICC malpostion
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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: mal-positioned PICC line in IJV
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    Case 6: PICC in azygous arch
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    Case 7: left PICC in the right subclavian vein
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