Why Choose a PICC

Why Choose a PICC?

There are many advantages in using PICC lines over other types of central access devices. The first, and probably the most popular, reason is cost effectiveness. PICC lines are much cheaper to insert and maintain compared to other types of central lines (Ng, et.al., 1997). Their potentially long dwell time also adds to their cost effectiveness.

Other advantages include increased arm mobility for the patient. PICC lines are very pliable and allow more freedom of arm movement than traditional peripheral access devices. The insertion length and pliability also reduce the risk of accidental dislodging of the catheter.

The patient and caregiver can be taught to care for the PICC line at home. Please note that it is very difficult for a patient to change a PICC dressing with one hand and it is suggested that there be a caregiver in the home to perform PICC line maintenance. Teaching the caregiver to do PICC line care could decrease the frequency of home care visits and result in cost savings for the patient.

Indications for using a PICC line are long term IV therapies which include:

antibiotics,
hydration,
pain management,
infusion of hyperosmolar fluids,
blood transfusion,
hyperalimentation,
some types of chemotherapy, and
continuous home inotropic therapy.

Contraindications can include sclerosis of the antecubital vessels. One might reconsider choosing a PICC line if the patient is unable to learn how to care for the line, has no caregiver in the home and has no access to home health or other types of nursing care that could assist with line maintenance.

The PASV (Pressure Activated Safety Valve) PICC line has a special valve on the end. The valve is activated to open by positive or negative pressure, such as a flush or aspiration. Otherwise, the valve remains closed, which keeps blood from entering the catheter. The catheter is designed to be accessed from the hub and certain types of saline lock devices can interfere with the valve. Flushing the PASV PICC requires only saline and the catheter should be flushed between medications and at least once a week when not in use.

Midline catheters were mentioned earlier (see Terms and Definitions and Anatomy and Placement pages). For practical purposes, keep in mind that midline catheters are seen in clinical practice, but may be confused with PICC lines.

True PICC lines are always centrally placed, with the tip located in the superior vena cava. The tip of the midline catheter rests below the axilla and is usually between 3 and 8 inches long. They can stay in place for up to 4 weeks and are ideal for prolonged IV therapy. However, due to potential complications such as phlebitis and thrombosis, midline catheters can only be used with fluids that have a pH from 5 to 9 and an osmolality between 500-600m Osmol/L.