A peripherally Inserted Central Catheter (PICC) is a thin, soft plastic tube that is used for giving intravenous fluids and medications. It is inserted through a peripheral vein, preferably in the upper arm and advanced until the tip of the catheter reaches a large vein above the heart.
A PICC line stays in place for as long as needed and up to two years if properly maintained. However, a PICC is not appropriate for all patients and hence proper patient selection is essential.
Veins Used for Insertion:
A PICC is generally inserted into the veins in the upper arm above the elbow. The veins which are used include the basilic vein, cephalic vein and brachial vein. The catheter is inserted into one of these veins and advanced until it reaches the Superior Vena Cava (SVC), one of the largest veins in the body. If necessary, other large veins, for example in the legs, are utilized if no other alternatives exist.
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Who Inserts a PICC Line?:
A PICC line insertion can be an inpatient or outpatient procedure and is performed by trained and qualified health care professionals such as radiologists, physician assistants, radiology assistants, or certified registered nurses.
A line can be inserted in one of three ways:
1) by feeling a vessel in the lower part of the arm followed by chest x-ray to confirm tip placement;
2) by ultrasound equipment to visualize a large vessel in the upper arm followed by a chest x-ray to confirm tip placement all done at the bedside; or
3) using ultrasound to visualize the vessel then utilizing fluoroscopy for a real-time image while advancing the catheter. Specially trained registered nurse performs the first two methods and a radiologist, nurse practitioner, or physician’s assistant inserts the line with fluoroscopy. After the insertion, the PICC is secured to the skin with an anchoring devised and dressed with a sterile dressing.
Technique Used to Insert:
There are two techniques used to insert a PICC. They are the Peel-Away Cannula Technique and the Modified-Seldinger Technique.
After inserting the PICC and the procedure is complete, the catheter is secured with an anchoring device to ensure it remains in place and does not migrate out from the insertion site. It is then sterilely dressed to protect the site from infection. It can be used immediately following confirmation of the catheter tip placement.
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