From the Guidelines
To write an order for a Peripherally Inserted Central Catheter (PICC) line, include the indication for placement, desired catheter type, preferred insertion site, catheter tip location, and specific care instructions, as seen in recent guidelines 1. When writing the order, consider the following essential elements:
- Indication for placement: specify the reason for the PICC line, such as long-term IV antibiotics or TPN administration
- Desired catheter type: choose from single, double, or triple lumen, depending on the patient's needs
- Preferred insertion site: typically the basilic or cephalic vein, avoiding the femoral vein due to increased risk of infection and thrombosis 1
- Catheter tip location: usually the superior vena cava-right atrial junction, verified by chest X-ray or intraoperative fluoroscopy 1
- Specific care instructions: include weekly dressing changes, daily line assessment, and maintenance of patency with normal saline rather than heparin 1 A complete order might read: "Insert PICC line, double-lumen, 5 French, preferably right basilic vein, tip placement at SVC-RA junction for long-term IV antibiotics. Confirm placement with chest X-ray before use. Maintain per institutional protocol with weekly dressing changes and daily line assessment." Additionally, consider patient factors that may affect placement, such as history of DVT, dialysis needs, or coagulopathy, and specify whether the patient requires sedation or has latex allergies 1.
From the Research
Writing an Order to Place a Peripherally Inserted Central Catheter (PICC) Line
To write an order for a PICC line placement, consider the following steps and information:
- The order should include the patient's identification and medical record number
- The reason for the PICC line placement, such as antibiotic therapy or total parenteral nutrition, should be specified 2, 3
- The type of catheter to be used, including the size and material, should be indicated
- The order should include any relevant medical history, such as allergies or previous central line placements
- The name of the healthcare provider responsible for inserting the PICC line should be included
Key Components of a PICC Line Order
Some key components to include in a PICC line order are:
- Patient demographics and medical record number
- Indication for PICC line placement
- Type and size of catheter to be used
- Insertion site, typically the antecubital vein
- Confirmation of proper placement, such as through ultrasound or fluoroscopy 4, 5
- Orders for flushing and maintenance of the PICC line
Considerations for PICC Line Placement
When writing an order for a PICC line placement, consider the following:
- The patient's overall health status and ability to tolerate the procedure
- Any potential complications, such as catheter-related sepsis or thrombophlebitis 6
- The need for ongoing monitoring and maintenance of the PICC line
- The potential for alternative routes of administration, such as a subclavian or internal jugular vein approach 3, 6