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Peripherally inserted central catheter
A peripherally inserted central catheter (PICC or PICC line), also called a percutaneous indwelling central catheter or longline, is a form of intravenous access that can be used for a prolonged period of time (e.g., for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition) or for administration of substances that should not be done peripherally (e.g., antihypotensive agents a.k.a. pressors). It is a catheter that enters the body through the skin (percutaneously) at a peripheral site, extends to the superior vena cava (a central venous trunk), and stays in place (dwells within the veins) for days, weeks or even months.
First described in 1975, it is an alternative to central venous catheters in major veins such as the subclavian vein, the internal jugular vein or the femoral vein. Subclavian and jugular line placements may result in pneumothorax (air in the pleural space of lung), while PICC lines have no such issue because of the method of placement.
Generally, PICC lines are considered when a person is expected to need more than two weeks of intravenous therapy. A PICC line can remain inserted for an extended period of time compared to other forms of central IV access, ranging from seven days up to several months as long as the line remains viable. They are utilized in both the hospital and community settings. They are commonly used in people receiving total parenteral nutrition (TPN), chemotherapy, or long term medications such as antibiotics. They may also be used to obtain a blood sample if the lumen is of sufficient size (at least 4 French gauge).
To help prevent the line from becoming clogged, the line should be regularly flushed with normal saline, and "locked" by filling it with heparin or normal saline when not in use.
A PICC line may not be inserted in a part of the body which is burned or has a local infection. Damage to the skin and surrounding tissue from radiation may also prevent the placement of a PICC line.
As with any intravenous line, there is the risk for sepsis – a severe bloodstream infection that can be life-threatening. The majority of infections associated with PICC lines occur after a median duration of use of 10 days, and during an intensive care unit stay. Adhering to strict infection control procedures, including aseptic technique, when inserting or using a PICC line will reduce the risk of an infection. There is also a risk of blood clots. The use of heparin to maintain a PICC line is not universal, as heparin locks have been associated with complications, including heparin-induced thrombocytopaenia.
Other complications may include catheter occlusion, phlebitis and bleeding. Urokinase or low-dose tissue plasminogen activator (tPA) may be required to break down obstructions, depending on the type and severity of the occlusion. A blood pressure reading can not be taken on an arm with a PICC line inserted.
A PICC is inserted in a peripheral vein such as the cephalic vein, basilic vein or brachial vein in the arm, and then threaded through the veins toward the heart, until the end of the catheter rests in the proximal superior vena cava or cavoatrial junction. They must be inserted by a trained medical professional, including a physician, but also any trained medical professional such as a specially trained registered nurse. and Interventional Radiology Technogists. An ultrasound or chest X-ray, the use of fluoroscopy, or electrocardiography navigation can be used during insertion and to confirm placement. The insertion is a sterile procedure, but does not need to be performed in a completely sterile environment like an operating room.
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Peripherally inserted central catheter
A peripherally inserted central catheter (PICC or PICC line), also called a percutaneous indwelling central catheter or longline, is a form of intravenous access that can be used for a prolonged period of time (e.g., for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition) or for administration of substances that should not be done peripherally (e.g., antihypotensive agents a.k.a. pressors). It is a catheter that enters the body through the skin (percutaneously) at a peripheral site, extends to the superior vena cava (a central venous trunk), and stays in place (dwells within the veins) for days, weeks or even months.
First described in 1975, it is an alternative to central venous catheters in major veins such as the subclavian vein, the internal jugular vein or the femoral vein. Subclavian and jugular line placements may result in pneumothorax (air in the pleural space of lung), while PICC lines have no such issue because of the method of placement.
Generally, PICC lines are considered when a person is expected to need more than two weeks of intravenous therapy. A PICC line can remain inserted for an extended period of time compared to other forms of central IV access, ranging from seven days up to several months as long as the line remains viable. They are utilized in both the hospital and community settings. They are commonly used in people receiving total parenteral nutrition (TPN), chemotherapy, or long term medications such as antibiotics. They may also be used to obtain a blood sample if the lumen is of sufficient size (at least 4 French gauge).
To help prevent the line from becoming clogged, the line should be regularly flushed with normal saline, and "locked" by filling it with heparin or normal saline when not in use.
A PICC line may not be inserted in a part of the body which is burned or has a local infection. Damage to the skin and surrounding tissue from radiation may also prevent the placement of a PICC line.
As with any intravenous line, there is the risk for sepsis – a severe bloodstream infection that can be life-threatening. The majority of infections associated with PICC lines occur after a median duration of use of 10 days, and during an intensive care unit stay. Adhering to strict infection control procedures, including aseptic technique, when inserting or using a PICC line will reduce the risk of an infection. There is also a risk of blood clots. The use of heparin to maintain a PICC line is not universal, as heparin locks have been associated with complications, including heparin-induced thrombocytopaenia.
Other complications may include catheter occlusion, phlebitis and bleeding. Urokinase or low-dose tissue plasminogen activator (tPA) may be required to break down obstructions, depending on the type and severity of the occlusion. A blood pressure reading can not be taken on an arm with a PICC line inserted.
A PICC is inserted in a peripheral vein such as the cephalic vein, basilic vein or brachial vein in the arm, and then threaded through the veins toward the heart, until the end of the catheter rests in the proximal superior vena cava or cavoatrial junction. They must be inserted by a trained medical professional, including a physician, but also any trained medical professional such as a specially trained registered nurse. and Interventional Radiology Technogists. An ultrasound or chest X-ray, the use of fluoroscopy, or electrocardiography navigation can be used during insertion and to confirm placement. The insertion is a sterile procedure, but does not need to be performed in a completely sterile environment like an operating room.