Monday, November 28, 2016

How To Place a Peripherally Inserted Central Catheter (PICC)

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. 

Uncut PICC
Source: Wikipedia

Pre Procedure

  • 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.

Technique

  • 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

Post Procedure


  • 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.


Left-sided PICC
Source: Wikipedia
For more details on interventional radiology procedures, check out the Handbook of Interventional Radiologic Procedures: