From the Guidelines
A PICC line should terminate at the level of the right atrial-superior vena cava junction. This location is recommended to ensure optimal blood flow for medication dilution and reduce the risk of complications such as thrombosis and cardiac arrhythmias 1. The tip position is critical, and placement too high in the SVC or into the right atrium can cause serious complications.
Key Considerations
- The location of the PICC line tip is crucial to minimize the risk of thrombosis and other complications 1.
- Imaging guidance, such as ultrasound or fluoroscopy, should be used to confirm proper placement of the PICC line 1.
- A chest X-ray is typically performed after insertion to verify correct positioning before the PICC line is used for medication administration or blood draws 1.
- The choice of central venous catheter type and location of exit site should be made by a multidisciplinary team, including an experienced specialist and the patient 1.
Recommendations
- The tip of the catheter should be placed at the level of the right atrial-superior vena cava junction 1.
- Right-sided access is preferable to a left-sided approach with respect to risk for thrombotic complications 1.
- Tunneled CVCs or totally implanted devices are recommended for long-term use 1.
- PICCs are not recommended for expected long-term use due to the higher risk of thrombosis and issues related to self-administration 1.
From the Research
Optimal Termination Location of PICC Lines
The optimal termination location of a Peripherally Inserted Central Catheter (PICC) line is a crucial aspect of its placement. According to the studies, the ideal location for the tip of a PICC line is:
- In the inferior 1/3 of the superior vena cava to the junction between the superior vena cava and the right atrium 2
- In the lower third of the superior vena cava 3
Importance of Accurate Placement
Accurate placement of the PICC line tip is essential to minimize the risk of complications, such as:
- Malpositioning, which can lead to incorrect medication administration or infusion of vesicants/irritants 3
- Spontaneous late migration, which can result in the catheter tip moving to an undesirable location, potentially causing serious complications 4, 5
Guidance Tools for PICC Placement
Various guidance tools and techniques are available to ensure accurate placement of the PICC line tip, including: