Peripherally inserted central catheter
Updates to Article Attributes
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 tunnelled 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 anaesthetic (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
haemorrhage
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/embolisation or accidental withdrawal
formation of fibrin sheath
infection, e.g. catheter- or wound-related (most common) 3
tip migration
-
periproceduralhaemorrhagearrhythmia-
arterial puncture: less common with image guidance2
-
malposition: less common with image guidance-
beware of anatomical variants such as aleft SVC
-
-
line fracture/embolisation or accidental withdrawal allergic reaction-
formation offibrin sheath
-<li>central venous access required for long-term IV administration of medication (e.g. chemotherapy or antibiotics) or parenteral nutrition</li>-<li>peripheral access with standard IV cannulae is difficult or impossible</li>- +<li><p>central venous access required for long-term IV administration of medication (e.g. chemotherapy or antibiotics) or parenteral nutrition</p></li>
- +<li><p>peripheral access with standard IV cannulae is difficult or impossible</p></li>
-<li>-<a href="/articles/basilic-vein-1">basilic</a> and <a href="/articles/brachial-vein">brachial</a> veins are most commonly used; preprocedure ultrasound can be performed to identify an appropriately-sized vessel and ensure it is clot-free</li>-<li>sterile preparation and drape; ensure tourniquet is tight</li>-<li>subcutaneous infiltration of local anaesthetic (e.g. lidocaine)</li>-<li>ultrasound-guided venous puncture followed by guidewire insertion; release the tourniquet</li>-<li>fluoroscopy to ensure guidewire position is venous</li>-<li>small skin incision at the puncture site</li>-<li>exchange puncture needle for peel-away sheath</li>-<li>removal of guidewire and insertion of PICC under fluoroscopic guidance to ensure tip is in an appropriate position (varies from institution to institution)</li>-<li>removal of the peel-away sheath</li>-<li>flush, secure and dress PICC</li>-<li>fluoroscopic spot acquisition/chest x-ray in inspiration to document correct position</li>-</ul><h4>Complications</h4><ul>-<li>infection, e.g. catheter- or wound-related (most common) <sup>3</sup>-</li>-<li>tip migration</li>-<li><a href="/articles/deep-vein-thrombosis">deep vein thrombosis</a></li>-<li>periprocedural<ul>-<li>haemorrhage</li>-<li>arrhythmia</li>-<li>arterial puncture: less common with image guidance</li>-</ul>-</li>-<li>malposition: less common with image guidance<ul><li>beware of anatomical variants such as a <a href="/articles/left-sided-superior-vena-cava-1">left SVC</a>-</li></ul>-</li>-<li>-<a href="/articles/line-fracture">line fracture</a>/embolisation or accidental withdrawal</li>-<li>allergic reaction</li>-<li>formation of <a href="/articles/fibrin-sheath">fibrin sheath</a>-</li>- +<li><p><a href="/articles/basilic-vein-1">basilic</a> and <a href="/articles/brachial-vein">brachial</a> veins are most commonly used; preprocedure ultrasound can be performed to identify an appropriately-sized vessel and ensure it is clot-free</p></li>
- +<li><p>sterile preparation and drape; ensure tourniquet is tight</p></li>
- +<li><p>subcutaneous infiltration of local anaesthetic (e.g. lidocaine)</p></li>
- +<li><p>ultrasound-guided venous puncture followed by guidewire insertion; release the tourniquet</p></li>
- +<li><p>fluoroscopy to ensure guidewire position is venous</p></li>
- +<li><p>small skin incision at the puncture site</p></li>
- +<li><p>exchange puncture needle for peel-away sheath</p></li>
- +<li><p>removal of guidewire and insertion of PICC under fluoroscopic guidance to ensure tip is in an appropriate position (varies from institution to institution)</p></li>
- +<li><p>removal of the peel-away sheath</p></li>
- +<li><p>flush, secure and dress PICC</p></li>
- +<li><p>fluoroscopic spot acquisition/chest x-ray in inspiration to document correct position</p></li>
- +</ul><h4>Complications</h4><h5>Periprocedural</h5><ul>
- +<li><p>haemorrhage</p></li>
- +<li><p>arrhythmia</p></li>
- +<li><p>arterial puncture: less common with image guidance</p></li>
- +<li><p>malposition: less common with image guidance. Beware of anatomical variants such as a <a href="/articles/left-sided-superior-vena-cava-1">left SVC</a></p></li>
- +<li><p>allergic reaction <sup>2</sup></p></li>
- +</ul><h5>Late</h5><ul>
- +<li><p><a href="/articles/line-fracture">line fracture</a>/embolisation or accidental withdrawal</p></li>
- +<li><p>formation of <a href="/articles/fibrin-sheath">fibrin sheath</a></p></li>
- +<li><p>infection, e.g. catheter- or wound-related (most common) <sup>3</sup></p></li>
- +<li><p>tip migration</p></li>
- +<li><p><a href="/articles/deep-vein-thrombosis">deep vein thrombosis</a> <sup>2</sup></p></li>
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