PICC
PICC stands for Peripherally Inserted Central venous Catheter. Peripherally inserted means it will be coming off the arms or legs. Central venous catheter means the tip of the catheter end in the largest vein of the body, called "vena cava"; the vena cava is in direct communication with the right atrium of the heart. PICCs come in different diameters, measured in "French" (abbreviated to "F"): 1F=0.3mm. The size of the PICC is selected based on the diameter of the veins of the patient. They can have one or more "lumens" depending on the needs. PICCs can be used to withdraw blood or to inject medications without the need to poke a vein every time. PICCs are employed when the therapy is likely to take longer than 1 week and can be left in site for several weeks.
Indications
Therapeutic
-Blood products infusion
-Parenteral nutrition
-Antibiotic therapy
-Chemotherapy
-Fluids and electrolytes infusions
-Other medications
Diagnostic
-Blood withdrawal
Possible Complications
General
-Pain: should go away within the day
-Infection: every device that is external to the body has a small chance of getting
infected
-Bleeding: oozing from the site of access is not uncommon, there are several ways
to mitigate it, ask your doctor or your nurse.
Procedure-related
-Clotting of the vein
-Heart stimulation: the tip of the PICC ends close or barely into the heart this
could cause the heart to have "extra-beats" the PICC in this case needs to be
replaced.
-Nerve or vessel damage: Ultrasound imaging is used to access the vein initially.
On ultrasound sometimes arteries look like veins and nerves may be difficult to
see
Rare
-No success: in certain patients there simply are not veins that can host a PICC;
this could be due to an extensive history of previous lines/PICCs placement,
dehydration or other causes. If the causes are reversible another attempt can be
made at a later date.
-Air embolism: air can get into the PICC and lodge in the vessels of the lung. The
effect is dose dependent (how much air enters the PICC and the circulation), and
can lead in extreme cases to cardiac arrest.
-X-ray exposure: to place a PICC correctly, the use of x-ray is necessary, however
the radiation dose needed is very low.
Risks related to having a line
-Clot: sometimes the PICC may occupy the whole diameter of the vein causing it
to clot.
-Vein narrowing: veins are made to move blood. Solid devices could cause
scarring of the vein by continuously rubbing on its walls and causing it to
eventually narrow.
-Infection: any medical device that enters the body can carry microbes into the
system.
-Heart stimulation: the tip of the PICC ends close or barely into the heart this
could cause the heart to have "extra-beats" the PICC in this case needs to be
replaced.
-Migration: any medical device in the body can migrate, meaning that it can move
from where it was placed. If that happens the device needs to be repositioned
-Fracture: any device can break. Some fractured part of a PICC can also move
usually to the heart or lungs. if that happens the broken part needs to be
retrieved.
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