A Peripherally Inserted Central Catheter (PICC) is essentially a fancy, extended intravenous line. The line is placed in the upper extremity above the antecubital fossa.
- Indications: nutrition, long term antibiotics
- Assess which side line should go on, check for prior PICC. For example, if the patient has a left sided pacemaker, place the PICC on the right.
- Place a tourniquet and assess veins using U/S
- Order of preference: Basilic > cephalic > brachial (near artery)
- In practice though, the brachial is often easier than the cephalic.
- After micropuncture access, pass the 0.018" microwire to the cavoatrial junction
- Exchange needle for peel-away sheath
- Exchange kit microwire for marked microwire in PICC kit (this step can be skipped by using the marked microwire primarily)
- Measure length
- For the average arm, approximately 40 cm usually.
- After prepping catheter, cut catheter to length obliquely
- Load catheter on wire, then feed through sheath
- Peel away sheath
- Flush each port, then lock with heparin 3-5 cc of 10 units / cc
- Affix PICC to arm with a sterile dressing
- Take final CXR. Catheter ready to use.
- The catheter can be removed on the floor by simply pulling, then holding pressure and putting a dress on afterwards.
For more details on interventional radiology procedures, check out the Handbook of Interventional Radiologic Procedures: