Peripherally inserted central catheter

Peripherally inserted central catheters (PICCs), often incorrectly tautologically termed PICC lines, are a type of central venous catheter predominantly used amongst oncology patients and those with chronic diseases (e.g. cystic fibrosis).

They offer the ability to have long-term central venous access without the need to have a surgically or radiologically-inserted tunnelled central venous catheter (e.g. Hickman catheter) or chest/brachial port.

Indications

• central venous access required for long-term IV administration of medication (e.g. chemotherapy or antibiotics) or parenteral nutrition
• peripheral access with standard IV cannulae is difficult or impossible

Technique

• basilic and brachial veins are most commonly used; preprocedure ultrasound can be performed to identify an appropriately-sized vessel and ensure it is clot-free
• sterile preparation and drape; ensure tourniquet is tight
• subcutaneous infiltration of local anesthetic (e.g. lidocaine)
• ultrasound-guided venous puncture followed by guidewire insertion; release the tourniquet
• fluoroscopy to ensure guidewire position is venous
• small skin incision at the puncture site
• exchange puncture needle for peel-away sheath
• removal of guidewire and insertion of PICC under fluoroscopic guidance to ensure tip is in an appropriate position (varies from institution to institution)
• removal of the peel-away sheath
• flush, secure and dress PICC
• fluoroscopic spot acquisition/chest x-ray in inspiration to document correct position

Complications

• infection, e.g. catheter- or wound-related (most common)
• tip migration
• deep vein thrombosis
• periprocedural
  • hemorrhage
  • arrhythmia
  • arterial puncture: less common with image guidance
• malposition: less common with image guidance
  • beware of anatomical variants such as a left SVC
• line fracture/embolization or accidental withdrawal
• allergic reaction

Siehe auch:

• Komplikationen ZVK
• zentraler Venenkatheter
• Fehlfunktion Fehllage Komplikationen peripher gelegter ZVK (PICC)