A internally inserted central catheter ( PICC or PIC line ), less commonly called central catheter in percutaneous , is a form of intravenous access that can be used for long periods of time (for example, for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition) or for the administration of substances that should not be done peripherally (eg, antihipotensive agents aka pressors). It is a catheter that enters the body through the skin (percutaneous) on the peripheral site, extends into the superior vena cava (vein), and remains in place for days or weeks.
First described in 1975, this is an alternative to central venous catheters in the major vein such as the subclavian vein, internal jugular vein or femoral vein. Subclavian placement and jugular lines can cause pneumothorax (air in the pulmonary pleural space), while PICC pathways do not have such problems due to placement methods.
Video Peripherally inserted central catheter
Medical use
In those who are very unhealthy, the PICC pathway is appropriate when it takes more than two weeks of treatment.
Maps Peripherally inserted central catheter
Side effects
Side effects include blood clots and infections.
Other complications may include catheter occlusion, phlebitis and bleeding. Urokinase or low-dose doses can be used to break the obstruction. The type of occlusion (caused by drug deposits or by thrombus) can determine which drug to use in an attempt to clear the ducts. To reduce the risk of infection, especially bloodstream infections, those involved in managing PICC must adhere to strict infection control procedures.
Insert
The PICC is inserted into the peripheral vein in the arm, such as the cephalic vein, basilic vein or brachial vein, and then leads proximally toward the heart through an increasing vein, until the tip is located in the superior cava vein or cavoatrial junction.
PICC is usually included by physicians, physician assistants (in the US), radiological assistants (in the US), respiratory therapists, nurse practitioners, certified nurses or certified radiology and radiology using ultrasound, chest radiography, and fluoroscopy to assist them in insertion and to confirm placement. Insertion of PICC is a sterile procedure, but does not require the use of the operating room. When performed beside the bed (ie, in the patient's room), the appropriate sterile field should be established and maintained during the procedure. For this reason, visitors are usually asked to leave the room until installation is complete, and some form of skin preparation should be used to clean the patient's skin.
The insertable portion of the PICC varies from 25 to 60 cm, which is sufficient to achieve the desired tip position in most patients. Some lines are designed to be trimmed to the desired length before being inserted; the other just put into the required depth with the remaining excess outside. As provided, the line has a guide wire in it. This wire is provided to strengthen the line (if not very flexible) so it can be passed through the blood vessels. Wire removed and discarded after insertion.
PICC is also equipped with "wings" that have holes for stitching or adhesive safety devices. Securing the catheter prevents post-insertion movement from the channel, which may otherwise put the tip in an unsafe position.
Usage
PICCs may remain in situ for a long period of time, from seven days to 4 months to 12 months although little information is available with respect to the survival period. They are used both in hospitals and community settings. PICCs can be used for intravenous administration of total parenteral nutrition (TPN), chemotherapy, antibiotics or other drugs, and can also be used for blood sampling if the lumen is 4 French or larger in size (Arrow and Bard manufacturer guidelines). To maintain patency, PICC management should include normal flushing with normal saline and "locking" with normal Heparin or saline when not in use. The type of locking procedure depends on the type of PICC and bung; Groshong PICCs have a three-way valve at the end so the use of a heparin key is not required, and no clamps on external length. By comparison, Arrow PICCs have clamps on the exterior lines and require heparin locks. The use of heparin to maintain line patency, though, is questionable, and current controlled clinical trials are investigating this further. The heparin lock has been associated with complications, including heparin-induced thrombocytopenia.
Blood pressure should not be taken in the arm with PICC, which is a problem if there is a reason not to take pressure on the other arm, such as dialysis shunt, absent, cast, infection, lymph node removal, etc. The blood pressure readings on the feet are often 10-20% higher than in the brachial artery.
Several types of PICC have recently been approved by the FDA for use in power injection. These types, often referred to as PICCs that can be injected power, are designed to withstand the high pressures associated with radiocontrast studies.
PICCs can also be used to measure central venous pressure, which is a rough estimate of the right atrial pressure of the heart and can provide valuable information about the fluid status.
Deletion
In many cases, PICC deletion is a simple procedure. Generally, catheter lines can be safely and quickly removed by trained nurses, even in the patient's own home, within minutes. After removal, the insertion site is usually wrapped with sterile gauze and kept dry for several days, where the wound can close and begin healing. Typically, smaller adhesive bandages may be placed above the wound site once the gauze is removed if the wound is slow to heal. The tip of the catheter is sent for MCS (microscopy culture and sensitivity) if the patient is not systemically healthy at the time of PICC removal. In certain units, it is sent as a routine investigation.
See also
- Central venous catheter
- Broviac catheter
- Hickman Lines
References
Further reading
- Bender, C. M., Rosenzweig, M., & amp; Green, E. (2006). "Cancer". In S. Goldsworthy & amp; M. A. Barry. Medical-Surgical Treatment in Canada: Assessment and Management of Clinical Problems. Mosby: Toronto. ISBNÃ, 0-7796-9969-6.
External links
- Description and image of PICC line insertion
Source of the article : Wikipedia
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