From the Guidelines
A PICC line order example would be: "Insert 5 French, double-lumen PICC line in the right basilic vein, with tip placement at the cavoatrial junction, for administration of TPN and IV antibiotics for 4 weeks, using maximal sterile barrier precautions during insertion, and flushing each lumen with 10mL normal saline after each use or every 24 hours if not in use, as recommended by recent guidelines 1.
Key Considerations
- The choice of central venous catheter type and location of exit site should be made by a multidisciplinary team, along with an experienced specialist and the patient 1.
- The tip of the catheter should be placed at the level of the right atrial-superior vena cava junction 1.
- Tunneled CVCs or totally implanted devices are recommended for long-term HPN, rather than PICCs, due to the higher risk of thrombosis and issues related to self-administration of HPN 1.
- PICC lines are generally preferred for short-term use, and are not recommended for expected long-term HPN 1.
Maintenance and Care
- Use of normal saline rather than heparin to maintain catheter patency and prevent lumen occlusion is recommended, as reflected in recent recommendations 1.
- Change transparent dressing every 7 days and change caps every 7 days, and monitor insertion site daily for signs of infection or complications.
- PICC lines can remain in place for weeks to months, reducing the need for repeated peripheral IV insertions, and allowing for delivery of medications that would be irritating to peripheral veins directly into larger central veins.
From the Research
PICC Line Order Example
- A PICC line order typically includes the following information:
- Type of catheter: e.g., 4-Fr single-lumen non-valved peripherally inserted central venous catheter 2
- Infusion protocol: e.g., long-term antibiotics 2
- Insertion technique: e.g., micropuncture technique by interventional radiologists 2
- Catheter care and maintenance: e.g., flushing with 5 ml of heparinized saline before and after each antibiotic infusion 2
- The order may also specify the desired catheter position, such as the border of the lower one-third of the superior vena cava (SVC) and cavo-atrial junction 3
- Additionally, the order may include information on patient education and support, such as pharmacy consultations and patient empowerment about side effects and precautions for use 4
Considerations for PICC Line Orders
- The choice of catheter type and insertion technique may depend on the patient's specific needs and medical history 5
- The risk of complications, such as thrombosis and infection, should be considered when ordering a PICC line 6, 3
- Regular monitoring and maintenance of the catheter are crucial to prevent complications and ensure effective use 2, 4