NCBI Bookshelf. Rafael Gonzalez ; Sebastiano Cassaro. Authors Rafael Gonzalez 1 ; Sebastiano Cassaro 2. It is especially vital for critically ill patients who often require frequent blood sampling, vasoactive medications, rapid fluid resuscitation, prolonged antibiotic administration and various other indications. Venous access can be obtained through conventional peripheral intravenous IV lines, midline peripheral catheters, and central venous catheters CVCs.
If you agree Insertion line picc the procedure, you can give consent for treatment by signing the consent form. The PICC line can be easily and repeatedly accessed without needle punctures to the patient. The Pine or nurse will use x-ray imaging or ultrasound during the procedure or take a chest x-ray immediately after to confirm the PICC line is correctly positioned. If this does happen, a chest x-ray will show the problem. That simply means they're not in the center part of your body. This includes going to daycare or school. Encourage your child to use their arm normally. Your child will wear a gown during the procedure. Hidden categories: CS1 errors: missing periodical CS1 maint: archived copy as title Use American English from Insertlon All Wikipedia articles written in American English Articles with short description Use mdy dates from January Articles needing additional references from April All articles needing additional references.
H r products model boat. How is a PICC Inserted?
Last Updated 22 October, The catheter is secured Insertjon the entry site with a suture wing and 2 sutures. A chest x-ray is done after placement to make sure that the catheter is properly placed. Mild soreness can be expected Online strip vids the entry site for one to two days after the procedure. After written informed patient consent is obtained, the procedure is performed Insertion line picc a radiology interventional procedure room and takes about an hour. PICC insertion is a sterile licc, but does not require the use Insertion line picc an operating room. To decrease the risk of infection, Insertiln a blood stream infection, those involved in the management of the PICC ipcc adhere to strict infection control procedures. A small needle is placed into a vein, followed by the insertion of the introducer needle, which serves to guide the PICC line towards your heart. Alternative Names. Temporary and Permanent Placement of Feeding Tubes. Drug injection. Always wash your hands before inspecting, cleaning, changing bandages or flushing your PICC line. Better Health Information from Doctors. Once daily, if you use the PICC line often.
A peripherally inserted central catheter PICC or PIC line , less commonly called a percutaneous indwelling central catheter , is a form of intravenous access that can be used for a prolonged period of time e.
- It can also be used to give larger volumes of fluids and medications that are too irritating to the tissue to be given through a standard IV.
- We are always pleased to assist you.
- A catheter is a thin plastic tube that is similar to an intravenous IV tubing used to allow patients to receive medications and fluids.
NCBI Bookshelf. Rafael Gonzalez ; Sebastiano Cassaro. Authors Rafael Gonzalez 1 ; Sebastiano Cassaro 2. It is especially vital for critically ill patients who often require frequent blood sampling, vasoactive medications, rapid fluid resuscitation, prolonged antibiotic administration and various other indications.
Venous access can be obtained through conventional peripheral intravenous IV lines, midline peripheral catheters, and central venous catheters CVCs. Peripherally inserted central catheters PICCs are a subset of central venous catheters. They are 50 cm to 60 cm long single, double or triple lumen catheters that are placed in a peripheral arm vein and terminate in the thorax.
They can be used for medium-term venous access, which is defined as anywhere between several weeks to 6 months. By definition, a central catheter is a venous access device that ultimately terminates in the superior vena cava SVC or right atrium RA.
PICCs are placed through the basilic, brachial, cephalic, or medial cubital vein of the arm. The right basilic vein is the vein of choice due to its larger size and superficial location. Additionally, it has the straightest route to its destination, as it courses through the axillary vein, then through the subclavian, and finally, settles in the SVC. However, given its location in the antecubital fossa, constant bending at the elbow increase the risk of complications such as mechanical phlebitis.
The cephalic vein is another option for PICC-line placement but, in addition to being smaller than the basilic vein, its course through the upper arm can be very tortuous. PICCs placed through this vein are thought to have a higher incidence of mechanical phlebitis, and its sharp angle of insertion makes it difficult to advance the catheter. The brachial vein is another option due to its larger size; however, it is smaller and runs deeper than the basilic vein.
It also courses close to the brachial artery and median nerve, and therefore, it usually requires ultrasound guidance for access. The PICC is a reliable and safe method for obtaining central venous access. Additionally, they can be managed in inpatient and outpatient settings. There are essentially no absolute contraindications to central venous catheterization, especially in emergent cases when the above indications are necessary for life-saving interventions.
There are, however, several relative contraindications for PICCs. PICC lines can differ in size 50 cm to 60 cm , the number of lumens single to triple , and care and maintenance routines. Additionally, they can be valved or non-valved. Valved catheters prevent backflow of blood into the catheter when the system is open.
Different brands of catheters may have subtle differences in their packaging and equipment. Below is a general list of standard equipment when using the modified Seldinger technique:. PICCs can be placed by any trained physician, registered nurse, or physician assistant. However, many institutions have dedicated teams of PICC nurses. These specially trained nurses have shown to increase success rates of catheter placement while decreasing complications through consistent proper, sterile technique in a cost-effective manner.
Central venous catheters can be placed surgically or non-surgically, although PICCs are typically placed non-surgically at the bedside using ultrasound guidance. Ultrasound guidance shows considerably improved outcomes. As with any procedure, preparation with is essential, and ensuring that all necessary equipment and materials are present is paramount for successful outcomes.
Sterile technique is especially vital for this procedure to decrease the risk of catheter-related bloodstream infections CRBSIs. Education of standardized catheter placement, care, maintenance and prevention of infection have been shown to reduce the incidence of CRBSIs drastically.
The entire procedure, including preparation for PICC placement, is outlined in the Technique section below. Peel-away cannulas or brake-away needle methods are other options. However, they require large veins to accommodate larger sized needles and introducers, which potentially exposes the patient to increased risk of excessive bleeding.
As with any indwelling catheter in the body, there is always the risk of infection. This can result in cellulitis, abscesses, or bacteremia and systemic infections. However, it is found to be higher in the inpatient setting 2. Infection rates are higher for PICCs placed in the antecubital fossa compared to those placed in the upper arm i. Other factors that increase the risk of infection are those that are not tunneled and those with multiple lumens.
However, devices impregnated with antimicrobial or antiseptic devices have been proposed to reduce the incidence of catheter-related infections. Although it may seem obvious to change catheters to prevent infection routinely, this is not the case for PICCs. PICC malposition is common.
They can be misplaced in the jugular vein, brachiocephalic vein, or azygous vein. When malposition occurs upon insertion, it is referred to a primary malposition. Migration is a change in the length of catheter extruding from the insertion site. When the catheter tip migrates spontaneously after initial placement in a proper location, it is referred to as secondary malposition.
Migration interferes the ability to withdrawal blood. However, it can also cause cardiac tamponade via erosion of the catheter through the RA or ventricle.
This is a medical emergency and must be addressed immediately. Catheter malposition and migration can be assessed using chest radiographs as well as by administering contrast die to determine the path of veins. Repositioning can be successfully achieved by trained nurses using simple bedside techniques i. Securing catheters at the insertion site can prevent tip migration. They can embolize during placement if sheared by needles or surgical instruments. Fractures of the internal portion of the catheter are also possible, which would possibly require removal through surgeons or interventional radiologists.
Phlebitis and infiltration are complications that occur in 2. It is a result of mechanical damage from the catheter itself or chemical irritation medications.
Phlebitis may occur within the first week after insertion and can be treated using non-steroidal anti-inflammatory agents or with the warm compress. Removal of the catheter is not necessary. If chemical irritation causes it, diluting medications or administering them at a lower rate can decrease inflammation. However, they can occur. They are caused by an inability to maintain a closed system between the catheter and vasculature.
Catheter damage, line disconnection, or lack of occlusive dressings are all capable of disrupting this closed system. Other causes of air emboli are lack of line flushing or improper flushing technique.
Like a cardiac tamponade, this is a medical emergency and requires immediate attention. It can be easily corrected by withdrawing catheter to its correct position and securing it to prevent migration.
In fact, one study reported a relative risk of 17 for developing clinical signs of thrombosis after an episode of central venous catheter-related infection. Other causes of occlusion can be non-thrombotic. Malpositioning, such as catheter abutment against the wall of a vessel or kinking, can cause occlusion. Common drugs known to precipitate are etoposide, calcium, diazepam, phenytoin, heparin and total parenteral nutrition.
It is important to properly flush catheters before and after blood collections and medication administration. Ensuring drug and solution compatibility can also prevent precipitation of medications.
Finally, repositioning a patient or the catheter itself can resolve occlusions from catheter kinking or abutment. Its scope of usage has since extended to into the outpatient setting. They provide medium-term venous access for several weeks up to 6 months, whereas non-tunneled CICCs typically use for several days. They can be easily placed and removed at the bedside by nursing staff whereas other central catheters, such as tunneled catheters and central ports, must be placed surgically.
They are a usually smaller bore, which is less useful for frequent blood draws though still possible using a syringe. Additionally, for patients requiring daily access for stem cell or blood product administration, surgically inserted central catheters are preferred. In conclusion, PICCs are an excellent option for various diagnostic and therapeutic interventions and offer clinicians and nurses a safe and effective option for central access.
The longevity of a PICC line is highly dependent on the care. Every hospital has its own protocol on how PICC lines should be looked after. Finally, nurses also play a vital role in educating other nurses on the usage of PICC lines and the importance of aseptic techniques. Only through such an approach can complications associated with PICC lines be minimized. The duration of PICC lines may be from 4 weeks to 6 months.
To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 UC Davis. Anatomy By definition, a central catheter is a venous access device that ultimately terminates in the superior vena cava SVC or right atrium RA.
Continuous administration of vesicants or drugs that irritate peripheral veins vasoactive drugs, chemotherapeutic agents.
Major anatomic abnormalities in the chest and neck that make central catheter placement difficult. Contraindications There are essentially no absolute contraindications to central venous catheterization, especially in emergent cases when the above indications are necessary for life-saving interventions. Persistent cough, vomiting increased intrathoracic pressure can lead to catheter malposition, catheter erosion or cardiac tamponade. Equipment PICC lines can differ in size 50 cm to 60 cm , the number of lumens single to triple , and care and maintenance routines.
Strenuous exercise should be done with caution to protect the PICC and only if permitted by your physician. Once the PICC is in the appropriate place, it can be secured to the skin outside of the insertion site. This usually does not hurt. A small bandage may be placed over the site if there is bleeding present that will remain in place 2 or 3 days while the wound heals. The procedure is typically done at the bedside if the patient is in the hospital, or as an outpatient procedure for other individuals. Your dressing should be inspected and changed regularly about twice a week. The patient is given a catheter information book with phone numbers and a pager number to call in the event of a question or emergency related to the PICC.
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In some instancies a PICC is used. PICC insertion procedures are performed by HSS radiologists and qualified and specially trained radiology nurses, radiology physician assistants and radiology nurse practitioners trained to safely use ionizing radiation, ultrasound and interventional vascular procedures. The final position of the PICC is confirmed by the radiologist on a chest X-ray obtained at the time of the procedure.
PICC catheters come in single lumen channel or double lumen types. After written informed patient consent is obtained, the procedure is performed in a radiology interventional procedure room and takes about an hour.
The patient is advised to lie on their back on a procedure table with the arm chosen for insertion resting on an arm board support. A tourniquet is placed around the arm just below the shoulder. The vein for the PICC access is selected using ultrasound. Local anesthesia may sting or burn for a few seconds but after that becomes numb, so only a pressure sensation is felt when the PICC is being inserted.
Under ultrasound guidance, a thin needle is used to enter the vein. A thin safety guidewire with a floppy safety tip is inserted through the needle, into the vein, and the tourniquet is loosened. The needle is then removed and the catheter is advanced through the vein over the guide wire to the superior vena cava. The indwelling guide wire is removed and an injection cap is attached to the catheter hub. The catheter is tested for blood return and then flushed with sterile, normal saline.
A final chest X-ray is performed to confirm catheter tip position. The catheter is secured at the entry site with a suture wing and 2 sutures. The insertion site is cleaned with an alcohol-based solution.
Sterile gauze is applied and covered with clear plastic adhesive dressing, and the upper arm circumference is measured to be used as a baseline. Prior to the procedure, information on medications like anticoagulant therapies such as Coumadin or Heparin is required.
A blood test to check for potential bleeding complications may be requested. Patients on anticoagulant therapy who have an INR blood test result greater than 2. An upper extremity vein cannot be used for a PICC insertion if there is a history of any of the following in the region of that upper extremity:. Pain can be expected during the injection of the local anesthetic and discomfort, or pain, may occur related to table positioning during the procedure. Adherence of the catheter within the venous system at the time of removal can occur when the catheter has been in dwelling for a long periods of time, although this is a rare occurrence.
Oral antibiotic therapy is an alternative in some cases, but may not be effective against certain types of infection or against infections in certain locations.
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PICC Line Placement in Children
The doctor or nurse inserts the PICC line, which is a thin tube, into a vein in the arm. The tube is advanced until it reaches the superior vena cava, a vein that carries blood to the heart.
Tell the doctor or nurse about your child's recent illnesses, medical conditions or allergies. List all the medications your child is taking, including herbal supplements and aspirin. You may be told to withhold aspirin, nonsteroidal anti-inflammatory drugs NSAIDs , or blood thinners several days prior to the procedure.
Some children, depending on their age, may be sedated for the procedure. Children who are not sedated are given a local anesthetic to numb the area where the catheter is inserted. A simple intravenous IV line delivers medication, nutrition and fluids during a short period of time. A PICC line can remain in place for weeks to months if needed, although rules may vary among different hospitals.
The PICC line can be easily and repeatedly accessed without needle punctures to the patient. Your child's blood may be tested before PICC line placement to check if certain blood levels are safe for the procedure. You should report all medications that your child is taking, including herbal supplements.
List any allergies, especially to local anesthetic , general anesthesia or to contrast materials containing iodine. Your child's doctor may advise you to withhold aspirin, nonsteroidal anti-inflammatory drugs NSAIDs or blood thinners a few days before the procedure.
Do not stop your child's medication until you have been given the doctor's approval. You will receive specific instructions on how to help your child prepare. These will include any changes to their regular medication schedule. You may be told to withhold food or drink several hours before the procedure if anesthesia or sedation is to be used.
Your child will wear a gown during the procedure. Jewelry, removable dental appliances, eye glasses and metal objects might interfere with the x-ray images. Therefore, they will need to be removed. In this procedure, ultrasound and x-ray equipment, a needle, a guide wire and a PICC line are used.
Ultrasound scanners consist of a console containing a computer and electronics. A video display screen and a transducer that is used to scan the body also are included. Ultrasound does not use radiation. Ultrasound is used to assess and identify a vein for catheter placement. It is used to look for veins that may be larger and deeper than veins that can be seen or felt on the skin surface.
Ultrasound gel is used to improve the quality of the image. Ultrasound is helpful because it provides the doctor or nurse with real-time guidance finding a vein. This helps improve the likelihood of a successful PICC line placement and to minimize the risk of complications, such as bleeding. Fluoroscopy, which converts x-rays into video images on a screen, is used to watch and guide the procedure. Fluoroscopy allows the doctor or nurse to watch the wire and catheter on a live display so they can safely advance the catheter into position.
A PICC line is a thin plastic or silicone tube catheter long enough to extend from a patient's arm vein to the largest vein near the heart the superior vena cava. A PICC line that does not extend as far as the superior vena cava is called a midline catheter. PICC lines may have as many as three openings and may be used for injection of medicine or contrast material.
Other equipment that may be used include devices to monitor your child's heart rate and blood pressure. PICC lines are occasionally placed in an operating room, or at the bedside without image guidance. PICC line placement can be performed on an outpatient or inpatient basis. Procedure length varies, although it usually takes about an hour to complete.
Your child will be placed face up on the table. Straps and bolsters may be placed to help your child remain still. An IV line will be inserted into a vein in the hand or arm if IV sedation is needed. The doctor or nurse will use ultrasound to identify the best vein to use for the procedure, usually a vein within the arm. Occasionally, a vein in the leg is used.
Tell the doctor or nurse in advance if your child has a strong preference for where the catheter is placed. The doctor or nurse will numb the area on the arm with a local anesthetic. A small needle will be inserted into the site using ultrasound as a guide. Next, a thin guide wire is inserted through the needle and moved through the vein using x-ray fluoroscopy or ultrasound guidance.
The catheter is advanced over the wire until the tip of the catheter is in an appropriate position. The guide wire is removed and the catheter is tested.
A special bandage is placed on the insertion site to keep the line secure. If image guidance was not used during placement of the PICC, an x-ray may be taken to ensure the catheter is correctly positioned.
If the procedure is done with sedation, the IV sedative will make your child feel relaxed, sleepy and comfortable for the procedure. Your child may not remain awake, depending on how deeply your child is sedated. A tourniquet a band tied tightly around the arm may be used to help enlarge the vein and make it easier to place the PICC line.
Your child may feel a slight pin prick when the IV line needle is inserted and the local anesthetic is injected. Your child may feel some pressure when the needle is placed into the vein.
If your child is not staying overnight at the hospital, they should rest at home for the remainder of the day. Your child may resume routine activities the next day, but should avoid lifting heavy objects for several days. If this occurs, hold pressure over the site until bleeding stops and call your doctor. Bleeding should stop within a few minutes. Your child may experience bruising, swelling and tenderness in the arm.
These symptoms clear up in a few days. Pain medicine may help during this time. You will receive instructions on how to help care for your child's PICC line. It is important to keep the catheter site clean and dry. Follow the advice you are given about bathing and showering with a PICC line.
The incision site should not be held under water such as by swimming or soaking in a tub. You may be advised to flush your child's catheter with a heparin solution. This will help keep blood clots from forming and blocking the catheter. When the decision is made to remove the PICC line, a health professional will remove it similar to the way an IV would be removed. The site will be covered with a bandage. The doctor or nurse will use x-ray imaging or ultrasound during the procedure or take a chest x-ray immediately after to confirm the PICC line is correctly positioned.
Your child's doctor or nurse will also check how well the device is functioning. This will be done by injecting fluid through the catheter using a syringe. PICC lines pose risks occurring during or shortly after placement.
There are also delayed risks that occur simply because the device is in your child's body. PICC line placement risks include:. Some patients have veins that are not well suited for a PICC line. This usually happens when these access veins have been used for a long period years of intravenous feeding, etc.
It may be very difficult to find a suitable vein in these patients. If this happens, the doctor or nurse will discuss other options for catheter placement. Please type your comment or suggestion into the text box below. Note: we are unable to answer specific questions or offer individual medical advice or opinions.
Some imaging tests and treatments have special pediatric considerations. To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database.
This website does not provide cost information. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the Radiological Society of North America RSNA and the American College of Radiology ACR , comprising physicians with expertise in several radiologic areas.
Outside links: For the convenience of our users, RadiologyInfo. Toggle navigation. What are some common uses of the procedure? How should my child prepare? What does the equipment look like? How is the procedure performed? What will my child experience during the procedure? What are the benefits vs. A PICC line may be used when patients need: prolonged IV antibiotic treatment medications that cannot be safely swallowed by the patient medications that cannot be safely delivered through a standard IV line chemotherapy anti-cancer drugs IV feeding for nutritional support repeated blood draws.
The skin at the PICC insertion site is cleaned and covered with a sterile surgical drape.