peripherally-inserted central catheter (PICC)
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Introduction
Implanted right atrial catheter
Classification
- Gershon catheter most common type
Indications
- aggressive chemotherapy
- prolonged antibiotic treatment
- parenteral hyperalimentation
- frequent blood draws for >= 6 days
- infusions or palliative care at end of life[4]
Contraindications
- chronic kidney disease stage 3b or higher[9]
- current or impending hemodialysis
- not for rapid infusion of blood products[1]
- avoid use in otherwise healthy children with infections if they can switch to an oral antibiotic[6]
Procedure
- catheter threaded into the superior vena cava.
- placement check by chest X-ray.
- initial dressing change within 24 hours with transparent dressing
- transparent dressing change
- routine weekly change
- change MWF for TPN & immunocompromised patients
- catheter flush with 10 mL of saline*
- prior to & after each blood draw & IV infusion
- blood draws:
* Volume in PICC about 2 mL.
# heparin used for flush in other types of catheter(s)
Complications
- upper-extremity deep venous thrombosis (DVT)* (RR=10.5)
- lower-extremity deep venous thrombosis (RR=1.48)[3]
- not associated with increased risk of pulmonary embolism[3]
- association between number of lumens in PICC lines & risk for complications, including intravenous catheter-associated infections, venous thromboembolism, & catheter occlusions
- PICCs placed before or after hemodialysis initiation diminish likelihood of successful transition to a working graft or fistula[1][8]
- for short-term indications, midline catheters associated with lower risk of bloodstream infection & occlusion compared with PICCs[10]
- major PICC-related complications occur in 15% of patients:
- occlusion in 10%
- central line-associated bloodstream infections in 2.5%
- deep venous thrombosis (DVT) in 3.6%
- pulmonary embolism in 0.6%[11]
- single lumen PICCs have less risk of venous thromboembolism & central line-associated bloodstream infections than multilumen PICCs[12]
- major PICC-related complications occur most frequently in cancer patients with
- ovarian cancer (26%)
- uterine cancer (19%)
- pancreatic cancer (18%)
- brain cancer (17%)[11]
* more common with PICCs than with other central venous catheters[3]; 10 fold increased risk[3]
Management
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2013, 2015, 2018.
- ↑ 2.0 2.1 WLA VAMC PICC line nursing
- ↑ 3.0 3.1 3.2 3.3 3.4 Journal Watch. June 6, 2013 Massachusetts Medical Society http://www.jwatch.org
Chopra V et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: A systematic review and meta-analysis. Lancet 2013 May 20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23697825 - ↑ 4.0 4.1 Chopra V et al The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015;163(6_Supplement):S1-S40. Sept 15, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26369828 <Internet> http://annals.org/article.aspx?articleid=2436759
- ↑ Greene MT et al. The association between PICC use and venous thromboembolism in upper and lower extremities. Am J Med 2015 Sep; 128:986 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25940453
- ↑ 6.0 6.1 American Academy of Pediatrics - Committee on Infectious Diseases and the Pediatric Infectious Diseases Society. Choosing Wisely. November 12, 2018 http://www.choosingwisely.org/societies/american-academy-of-pediatrics-committee-on-infectious-diseases-and-the-pediatric-infectious-diseases-society/
- ↑ 7.0 7.1 Bozaan D, Skicki D, Brancaccio A et al. Less lumens-less risk: A pilot intervention to increase the use of single-lumen peripherally inserted central catheters. J Hosp Med 2019 Jan 8; 14:42 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30379146 https://www.journalofhospitalmedicine.com/jhospmed/article/177747/hospital-medicine/less-lumens-less-risk-pilot-intervention-increase-use
- ↑ 8.0 8.1 McGill RL, Ruthazer R, Meyer KB, Miskulin DC, Weiner DE. Peripherally Inserted Central Catheters and Hemodialysis Outcomes. Clin J Am Soc Nephrol. 2016 Aug 8;11(8):1434-40. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27340280 Free PMC Article
- ↑ 9.0 9.1 Paje D, Rogers MAM, Conlon A et al. Use of peripherally inserted central catheters in patients with advanced chronic kidney disease: A prospective cohort study. Ann Intern Med 2019 Jun 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31158846 https://annals.org/aim/article-abstract/2735181/use-peripherally-inserted-central-catheters-patients-advanced-chronic-kidney-disease?doi=10.7326%2fM18-2937
- ↑ 10.0 10.1 Swaminathan L, Flanders S, Horowitz J et al. Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: A multicenter study. JAMA Intern Med 2022 Jan; 182:50-58. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34842905 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2786212
- ↑ 11.0 11.1 11.2 Mitbander UB et al. Patterns of use and outcomes of peripherally inserted central catheters in hospitalized patients with solid tumors: A multicenter study. Cancer 2022 Oct; 128:3681 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35943390 https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.34410
- ↑ 12.0 12.1 Bredenberg E et al. Promoting appropriate midline catheter and PICC placement through implementation of an EHR-based clinical decision support tool: An interrupted time-series analysis. J Hosp Med 2023 Jun; 18:483. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37052429 https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.13093