A PICC line provides the best concerning venous access. Similar to a standard IV, it is inserted in the arm, and usually in the upper arm under the benefits of ultrasound visualization. Also, PICCs differ from peripheral IV access but similar to central lines in that a PICCs termination point is centrally located in the body allowing for treatment that could not be obtained from standard periphery IV access. In addition, PICC insertions are less invasive, have decreased complication risk associated with them, and remain for a much longer duration than other central or periphery access devices (Info/Q&A:PICC line nursing).
PICCs are frequently used to obtain central venous access for patients in acute care, home care and skilled nursing care. Since complication risks are less with PICC lines, it is preferred over other forms of central venous catheters. A PICC is not appropriate for all patients. Proper selection to determine the appropriateness of this device is required (Info/Q&A:PICC line nursing).
Long-term central venous access is essential for managing patients with cancer, certain congenital malformations, gastrointestinal malfunction, as well as for those who need long-term access to medications or blood products. Peripherally inserted central catheters address all of these issues. They are considered a safe and effective alternative to other conventional and central venous access devices, are less invasive providing long term access with decreased risks (Info/Q&A:PICC line nursing).
The peripherally inserted central catheter has been an established technology in home intravenous therapies and its use has been increasing in hospital and home-health settings. PICCs adequately and safely meet the needs of patients who require short to long term therapy in many clinical settings.
The various advantages of peripherally inserted central catheters are: long term venous access; low risk for infection; decreased skin puncture for blood sampling; early patient discharge; versatility (Info/Q&A:PICC line nursing).
Some of the complications associated with PICC lines include: air embolism; infection; phlebitis; catheter malposition; thrombus formation; difficult removal; nerve injury or irritation; nerve injury or irritation; leakage; catheter breakage (Info/Q&A:PICC line nursing).
The range of clinical presentations in patients receiving a CVC is broad. They may be hypovolemic or in shock with severely vasoconstricted peripheral sites. They may be an oncology patient or may have bacteremia and require continuous intravenous (IV) access for prolonged periods, thereby requiring an accessible IV site. Patients with bloodstream infections (BSIs) or catheter-related infections may have redness, exudate, swelling, or increased pain at the insertion site. They may only have an elevated temperature or abnormal vital signs if immunocompromised (Putigna).
Contraindications for inserting a central venous catheter include an infection or burn over the desired insertion site, a known venous thrombosis of the vessel, an uncorrected coagulopathy, an obstruction of the vein by a tumor or mass, an abnormal vessels, an ability to achieve the same objectives with a peripheral line, and a lack of consent in a nonemergency setting. A relative contraindication is bacterial septicemia because cultures are generally recommended to be sterile for 36-48 hours prior to CVC insertion (Putigna).
Info/Q&A:PICC line nursing. (n.d.). Retrieved November 11, 2008, from PICC Line Nursing: http://picclinenursing.com/picc_why.html
Putigna, F. (n.d.). Central Venous Access: Emedicine. Retrieved November 11, 2008, from Emedicine: http://www.emedicine.com/ped/topic3052.htm