PICC catheter
The PICC (PICC, Peripherally Inserted Central venous Catheter = 'peripherally inserted central venous catheter', also PICC-Line) is a central venous access , first described in 1975 , in which the central venous catheter is inserted through a vein in the upper arm. PICCs are used for drug administration , blood collection and high-pressure injection of contrast media . PICCs are an alternative to the central venous catheter (CVC) due to their lower complication rate and longer residence time . They are mainly used in medium-term intravenous therapy (1 to 3 months). PICCs can be used for home treatment.
Material and use
PICCs are thin, flexible plastic tubing 3–6 French (1.0–2.0 mm) in diameter . The entry of the PICCs into the venous system takes place in the area of the deep humerus veins. The catheter tip lies in the area of the transition from the superior vena cava to the right atrium. The length is individually adapted to the patient. PICCs are suitable for both taking blood and administering medication. Special PICCs are also approved for the high pressure injection (up to 4 ml / s and up to a pressure of 325 psi) of contrast media in computed tomography (CT) or magnetic resonance imaging (MRT). PICCs have the advantage of being relatively easy to implant, but also easy to remove. They are mainly used in medium-term central venous therapy (1–3 months). Since the catheters are inserted peripherally, good blood clotting does not have to be taken so seriously during implantation.
Implantation of a PICC
PICCs are placed under local anesthesia and under ultrasound and X-ray control . For this purpose, a superficial ( basilic vein ) or deep ( brachial vein) vein of the upper arm is punctured with a cannula and then the catheter is inserted into the vein using the Seldinger technique , i.e. with the help of a guide wire. At the entry point on the upper arm just above the elbow, the catheter is fixed with a special adhesive plate and covered with a transparent sterile bandage.
In contrast to the other central venous catheters, with the PICC implantation, a vein of the upper arm is punctured under ultrasound guidance and not a central vein. As a result, there are significantly fewer complications to fear during implantation. A PICC can therefore also be placed on critically ill patients or patients with poor coagulation. The combination of sonographically controlled venipuncture and X-ray controlled placement of the PICC catheter can further reduce the possible risks.
Complications
Possible complications are the bleeding and the formation of a bruise, the malpuncture of the humerus artery and the puncture of a nerve. In addition, infection or the formation of an abscess, as well as thrombosis of the vein or catheter, can occur in the further course .
maintenance
PICCs are regularly flushed with 0.9% saline solution. The PICC's adhesive plate and sterile dressing are changed weekly. With appropriate care and provided no complications arise, a PICC can be left on for longer than three months.
See also
literature
- Moureau, Nancy: Vascular safety: It's all about PICCs . In: Nursing Management . 37, No. 5, May 2006, pp. 22-27. PMID 16651899 .
- Daniela Kildal (ed.): Medical foreign bodies in imaging: thorax, abdomen, vessels and children , Springer, February 2016, p. 428, ISBN 3-662-47296-1 .
Web links
- Website of the Clinic for Radiology at the Charité - Universitätsmedizin Berlin about PICC catheters
Individual evidence
- ↑ Hoshal, VL: Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters . In: Archives of Surgery . 110, No. 5, May 1975, pp. 644-646. doi : 10.1001 / archsurg.1975.01360110190032 . PMID 805577 .
