Peripherally inserted central catheter

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.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 or weeks. 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. In those who are very unwell PICC lines are appropriate when more than two weeks of treatment is needed. Side effects include blood clots and infection.. The majority of infections occur after a median of 10 days, and during an ICU stay. Other complications may include catheter occlusion, phlebitis and bleeding. Urokinase or low-dose tPA may be used to break down obstructions. The type of occlusion (caused by medication precipitate or by thrombus) may determine which drug will be used in an attempt to clear the line. To decrease the risk of infection, particularly a blood stream infection, those involved in the management of the PICC must adhere to strict infection control procedures. A PICC is inserted in a peripheral vein in the arm, such as the cephalic vein, basilic vein or brachial vein, and then advanced proximally toward the heart through increasingly larger veins, until the tip rests in the distal superior vena cava or cavoatrial junction. PICCs are usually inserted by physicians, physician assistants (in the US), radiologist assistants (in the US), respiratory therapists, nurse practitioners, or specially trained certified registered nurses and radiologic technologists using ultrasound, chest radiographs, and fluoroscopy to aid in their insertion and to confirm placement. PICC insertion is a sterile procedure, but does not require the use of an operating room. When done at bedside (that is, in the patient's room), a suitable sterile field must be established and maintained throughout the procedure. For this reason, visitors are normally requested to leave the room until the insertion is complete, and some form of skin preparation should be used to clean the patient's skin.