Peripherally Inserted Central Catheters, commonly known as PICCs, are long, thin tubes that are inserted into an arm vein and threaded into larger veins until the tip rests in a large vein near the heart. PICCs are used for frequent or long-term administration of medications, blood transfusions, fluids, nutrition or chemotherapy treatments. They allow for reliable venous access without the risks associated with repeated sticks and multiple intravenous lines.
How are PICCs inserted?
Peripherally Inserted Central Catheters placement is performed by specially trained nurses called PICC nurses. Before insertion, the patient's veins are examined to find the best vein for catheter placement. The procedure is done at the patient's bedside or in an interventional radiology suite under ultrasound guidance. Local anesthesia is used to numb the skin and veins. The catheter is gently threaded through the selected arm vein until the tip rests in the proper place in the upper chest. X-rays are often taken to confirm the tip location before securing the catheter. The entire procedure takes 30-60 minutes on average.
What types of PICCs are available?
There are different types of PICCs available based on materials and design:
- Straight PICCs: Traditional Peripherally Inserted Central Catheters Industry made of flexible polyurethane or silicone that remain straight from insertion point to tip.
- Power PICCs: Contain an internal coil that reduces kinking and straightens if bent. Allows for greater patient mobility.
- Antimicrobial PICCs: Coated with antimicrobial agent to reduce risk of infection compared to non-coated catheters.
- Chemoports: Have a subcutaneous port connected to distal catheter end, allowing for needle-free access. Used frequently for chemotherapy.
The choice depends on intended use, duration, and patient characteristics/needs. Straight PICCs tend to be less expensive while power and antimicrobial PICCs have additional design benefits.
What are the benefits of PICCs over other central lines?
Some key benefits of PICCs compared to non-tunneled central lines like peripherally inserted central venous catheters (PICCs) include:
- Ease of insertion: PICCs are inserted percutaneously into an arm vein and do not require surgical placement like other central lines. This makes procedures faster with less risk.
- Long-term use: PICCs can remain in place for several weeks or months to provide consistent central venous access for prolonged treatments.
- Less risk of infection: When compared to other non-tunnelled catheters like CVCs, research shows PICCs have a lower risk of complications like infusion-related bloodstream infections.
- Comfort and mobility: As the catheter enters through the arm, PICCs are less likely to cause restriction of mobility or daily activities compared to neck or chest lines.
- Cost-effectiveness: Overall costs tend to be lower with PICCs than other short-term or tunneled central lines when factoring in placement, materials, and reduced risk of complications.
- Reliability: PICC placement has a high success rate and rigorous guidelines help ensure proper tip placement and function compared to other short-term alternatives.
Potential risks and complications of PICCs
While low-risk overall, some potential issues can arise with PICCs, especially in high-risk patients or with long-term indwelling:
- Infection: As with any foreign body, there is a small risk of a localized infection at the insertion site or bloodstream infection from bacteria traveling along the external or internal catheter surface. Risk is estimated around 3-7% depending on individual factors and care practices. Proper care and regular assessment by clinicians can help prevent infection.
- Thrombosis: Catheters that rest near the heart have a small inherent risk of causing blood clots (thrombi) to form on the catheter surface or tip. This occurs in around 5-10% of PICC insertions depending on individual risk factors. Use of anticoagulant dressings and measures like meticulous hygiene can help reduce this risk.
- Accidental Removal or Dislodgment: Over time, catheters can accidentally get pulled out by the patient or dislodged from original placement point if securement and dressings are inadequate or the patient is very active. Rates are estimated around 3-5% and careful suturing/dressing reduces this risk.
- Leakage or Breakage: In rare cases, less than 1%, the catheter material itself can develop tiny holes or fractures leading to leakage or breakage. Using quality materials from trusted suppliers helps prevent this problem.
- Malposition: X-ray confirmation of proper tip placement is important as the catheter can on rare occasions be inadvertently threaded too far up or in the wrong direction, necessitating repositioning.
Nurse-Led PICC Team Care
Most hospitals now have dedicated PICC nurse teams that specialize in all aspects of care to optimize outcomes:
- Placement: Nurses experienced in ultrasound-guided insertion perform all initial placements to ensure proper tip placement and reduce risk of complications.
- Assessment: Regular patients assessments check for signs of infection, dislodgment, leakage or clotting. Dressings are also inspected and changed following protocol to prevent infection.
- Troubleshooting and Removal: The PICC team manages any issues like occlusion or malposition to determine if solutions
Get This Report In Japanese Language
Get This Report In Korean Language
About Author:
Ravina Pandya Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc.
