From the Guidelines
PICC lines are the preferred choice for long-term intravenous access, especially for patients requiring extended treatments like chemotherapy, long-term antibiotics, or total parenteral nutrition, due to their reduced need for repeated needle sticks, ability to deliver medications that would irritate smaller veins, and lower risk of complications compared to other central lines. When considering the use of PICC lines, it's essential to weigh the benefits against potential complications, such as infection, blood clots, catheter damage, or migration of the line 1. The procedure for inserting a PICC line is typically performed by specially trained nurses or physicians using ultrasound guidance and sterile technique, and patients with PICC lines need to keep the insertion site clean and dry, watch for signs of infection, and avoid submerging the site in water. Some key considerations for the use of PICC lines include:
- The expected duration of use, with PICC lines being suitable for extended treatments lasting weeks to months 1
- The type of medication or fluid being administered, with PICC lines being preferred for irritants or vesicants such as parenteral nutrition or chemotherapy 1
- The availability of skilled operators, with nontunneled CVCs being an alternative option for shorter durations of use 1
- The patient's individual needs and preferences, with tunneled catheters and implanted ports being reserved for instances where PICC use is not feasible or is relatively contraindicated 1. Overall, PICC lines offer a convenient and relatively safe option for long-term intravenous access, but their use should be carefully considered on a case-by-case basis, taking into account the latest evidence and guidelines, such as those outlined in the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 1.
From the Research
PIC Line Overview
- A Peripherally Inserted Central Catheter (PICC) is a type of catheter used to provide intravenous access for patients requiring long-term treatment 2, 3, 4, 5, 6.
- PICCs are inserted through a vein in the arm and guided to a larger vein in the chest, allowing for the delivery of medications, nutrients, and fluids directly into the bloodstream.
Advantages and Safety
- PICCs have been shown to have similar rates of central line-associated bloodstream infections (CLABSIs) compared to traditional central venous catheters (CVCs) 2.
- The use of PICCs can reduce the risk of complications and infections associated with repeated venepunctures and central devices 5.
- PICCs can be used safely and effectively for total parenteral nutrition (TPN) and are associated with an acceptable rate of complications 6.
Insertion and Maintenance
- PICCs can be inserted using ultrasound-guided vein selection and electrocardiograph (ECG)-guided central line tip placement, eliminating the need for radiological confirmation 4.
- The development of nurse-led community-based PICC insertion services has been shown to reduce treatment delays and the need for secondary care intervention 4.
- Complications related to PICC insertion and maintenance, such as catheter malposition, migration, venous thrombosis, and line fracture, can be identified and managed through imaging techniques 3.