Introduction


Peripherally inserted central catheters, also known as PICC lines, are widely used in both the inpatient and outpatient settings. PICC lines provide central venous access with a safety profile superior to permanent central venous catheters (CVC) in the out-patient setting and similar to CVCs in the inpatient setting. Specifically, out-patient PICCs were associated with fewer central line associated bloodstream infections (CLABSI) than were CVCs in the outpatient setting. PICCS are also associated with lower cost than permanent CVC. PICC insertion is well tolerated and patients appreciate the convenience versus repeated IV insertions.

PICC lines can be used for short-term or extended therapy, usually from 7 days up to a year. Permanent tunneled central venous catheters may be surgically implanted for therapies expected to last more than a year. Insertion of any venous access device (VAD) involves risk but PICC lines have been shown to provide benefits that outweigh those risks. PICC lines allow the infusion of medications that cannot safely be delivered through short peripheral catheters.

Catheter related blood stream infection (CRBSI) is a common complication of VAD. A number of studies, including the 2006 Pronovost study have demonstrated that CRBSI can be reduced to a rare occurrence. Sutter Roseville Medical Center (SRMC), a 270-bed community hospital in Roseville, California using a central line bundle (evidence-based protocol) inserted 2,278 PICCs in 2007 without one incidence of CRBSI. The CDC recently published CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections.

Puncturing a vessel and inserting a VAD disrupts the intimal layer. Intimal disruption increases the risk of thrombus formation. A recent study by Evans and Sharp, et al. has identified the rate of symptomatic deep venous thrombosis (DVT) associated with PICCS inserted in the arm to be about 3%. They also found that insertion of a PICC following a surgery that lasted over 1 hour or insertion of a multi-lumen PICC catheter increased the risk of a symptomatic DVT.

This course will discuss risks and benefits of PICC lines, identify insertion and removal considerations, discuss care and management of a PICC line and patient education for home care. The procedures outlined here are based upon an evolving standard of care and manufacturer's guidelines. Institutions may have slightly different policies and procedures. Your facility's policies and procedures are your best guide to safe patient care.


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