From the Guidelines
The correct placement for a Peripherally Inserted Central Catheter (PICC) is with the tip located in the lower third of the superior vena cava (SVC), at or near the cavoatrial junction, as recommended by the most recent and highest quality study 1. This position ensures optimal blood flow around the catheter tip, reducing the risk of thrombosis while maintaining proper functionality.
Key Considerations for PICC Placement
- The PICC is typically inserted through a peripheral vein in the upper arm, usually the basilic, brachial, or cephalic vein, and then advanced through the venous system until the tip reaches the desired location.
- Proper placement should be confirmed via chest X-ray or fluoroscopy before the catheter is used for medication administration or blood sampling.
- Malposition can lead to serious complications including thrombosis, catheter dysfunction, cardiac arrhythmias, or vessel erosion.
- The insertion procedure should be performed using maximal sterile barrier precautions to minimize infection risk, as emphasized in the guidelines 1.
- Once placed, the external portion of the catheter should be secured to the skin without tension to prevent migration or accidental dislodgement.
- Regular assessment of the insertion site for signs of infection or complications is essential throughout the duration of PICC use.
Importance of Correct Placement
The position of the catheter tip plays a critical role in preventing complications, and evidence shows that infusion of high osmolarity PN in the lower third of the superior vena cava or at the atrio-caval junction is associated with the least incidence of mechanical and thrombotic complications 1.
Placement Technique
The use of ultrasound guidance and the micro-introducer technique is recommended for PICC placement, as it increases the rate of success and reduces the incidence of local complications such as thrombophlebitis 1.
From the Research
Correct Placement for PICC
The correct placement of a Peripherally Inserted Central Catheter (PICC) is crucial for the treatment of patients. According to the studies, the best tip position of PICC is located in the inferior 1/3 of the superior vena cava to the junction between the superior vena cava and the right atrium 2.
Key Considerations
- The tip of the catheter should be placed at the lower segment of the superior vena cava, near the right atrium 3, 4.
- The use of electrocardiogram (ECG) guidance, ultrasound, and X-ray positioning can help ensure accurate placement of the PICC tip 2, 3, 5, 4.
- The placement of PICC through a superficial femoral vein is also feasible in patients with superior vena cava syndrome, using ultrasound guidance and ECG positioning technology 3.
Placement Techniques
- ECG-guided PICC placement system can be a preferable method for accurately measuring the exact position of the PICC within the venous system 4.
- Intracavitary electrocardiogram (IC-ECG) guidance can also be used for PICC placement, especially in cases with persistent left superior vena cava (PLSVC) 5.
- X-ray examination can be used to confirm the position of the catheter tip after placement 3, 5.