Peripherally inserted central catheter
A peripherally inserted central catheter (PICC or PICC line), also called a percutaneous indwelling central catheter or longline,[1] is a form of intravenous access that can be used for a prolonged period of time (e.g., for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition) or for administration of substances that should not be done peripherally (e.g., antihypotensive agents a.k.a. pressors). It is a catheter that enters the body through the skin (percutaneously) at a peripheral site, extends to the superior vena cava (a central venous trunk), and stays in place (dwells within the veins) for days, weeks or even months.
First described in 1975,[2] it is an alternative to central venous catheters in major veins such as the subclavian vein, the internal jugular vein or the femoral vein. Subclavian and jugular line placements may result in pneumothorax (air in the pleural space of lung), while PICC lines have no such issue because of the method of placement.
Risks and complications[edit]
As with any intravenous line, there is the risk for sepsis – a severe bloodstream infection that can be life-threatening. The majority of infections associated with PICC lines occur after a median duration of use of 10 days, and during an intensive care unit stay.[8] Adhering to strict infection control procedures, including aseptic technique, when inserting or using a PICC line will reduce the risk of an infection.[9] There is also a risk of blood clots.[3] The use of heparin to maintain a PICC line is not universal, as heparin locks have been associated with complications, including heparin-induced thrombocytopaenia.[10]
Other complications may include catheter occlusion, phlebitis and bleeding. Urokinase or low-dose tissue plasminogen activator (tPA) may be required to break down obstructions, depending on the type and severity of the occlusion. A blood pressure reading can not be taken on an arm with a PICC line inserted.[11]