- Peripherally inserted central catheter
A peripherally inserted central catheter (PICC or PIC line) is a form of
intravenousaccess that can be used for a prolonged period of time, e.g. for long chemotherapyregimens, extended antibiotic therapy or total parenteral nutrition. First described in 1975, [Hoshal VL. Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters. "Arch Surg" 1975;43:1937–43. PMID 805577.] it is an alternative to subclavian lines, internal jugular lines or femoral lines which have higher rates of infection. Subclavian and internal jugular line placements may result in pneumothorax(air in the pleural space of lung).
A PICC is inserted in a peripheral
vein, such as the cephalic vein, basilic vein, or brachial veinand then advanced through increasingly larger veins, toward the heart until the tip rests in the distal superior vena cavaor cavo-atrial junction.
PICCs are usually inserted by
radiologists, physician assistants, radiologist assistants, or certified registered nurses using ultrasound, chest radiographs and fluoroscopyto aid in their insertion and to confirm placement. Complications may include catheter occlusion, phlebitis, hemorrhage, thrombosisand infection. Urokinasemay be used to lyse obstructions. PICC lines generally will remain in place no longer than 30 days, although duration of use varies from just a few days in patients requiring short courses of chemotherapy or biotherapyto a year for patients requiring longer treatment. Commonly, other forms of intravenousaccess are considered if the treatment course is protracted. While replacement is generally considered a year post-insertion, patients have survived with the same PICC in situ for several years without complication.
Certain types of PICCs have recently been approved by the FDA for use in power injection. These PICCs, often referred to as "POWER PICCs", are designed to withstand the high pressures associated with
*Bender, C.M., Rosenzweig, M. & Green, E. (2006) Cancer. In S. Goldsworthy & M.A. Barry. "Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems". (1st Canadian ed). Mosby: Toronto. ISBN 0779699696.
* [http://www.cancerbackup.org.uk/Treatments/Chemotherapy/Linesports/PICCline Description and images of PICC line insertion]
* [http://www.bardaccess.com Bard Access Systems]
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