An Overview of Peripherally Inserted Central Catheters

Leigh A. Bowe-Geddes, RN, BS, CRNI; Heather A. Nichols, RN, BSN, CRNI

Disclosures

Topics in Advanced Practice Nursing eJournal. 2005;5(3) 

In This Article

Abstract and Introduction

Abstract

Peripherally inserted central catheters (PICCs) are frequently used to obtain central venous access for patients in acute care, home care and skilled nursing care. PICCs are a reliable alternative to short-term central venous catheters, with a lower risk of complications. Early assessment of hospitalized patients is essential to assure that individuals who will benefit the most from a PICC receive one as soon as possible in their treatment. However, PICCs are not appropriate for every patient. Indications, contraindications, and potential complications must be considered prior to insertion of a PICC. Nurses caring for patients with PICCs must be properly educated in device use, site care, and catheter maintenance, as well as recognition of complications. This article presents a comprehensive review of the core issues related to PICC use by nurses.

Introduction

PICCs have become well recognized as reliable central venous access devices (VADs), with lower potential for complications than short-term central venous catheters.[1,2,3,4] PICCs first gained popularity in the 1980s, and their use has grown steadily since then. They were initially popular in many parts of the United States due to the need for venous access in home care patients. They have grown in popularity because of their reduction in potential complications and costs compared with short-term central venous catheters, and because PICCs can be inserted by registered nurses who have been trained in the procedure.[5]

For a VAD to be termed a PICC, it must be inserted into the peripheral vasculature. A vein in the arm is the most common point of insertion. Also, to meet the definition, the distal tip of the catheter must terminate in the superior vena cava, the inferior vena cava, or the proximal right atrium. For infants, the catheter may be inserted in the saphenous vein, with tip termination in the inferior vena cava above the level of the diaphragm. Any tip termination below the level of the diaphragm for lower extremity insertion, or proximal to the superior vena cava for upper extremity insertion, is technically not a PICC but rather a peripheral catheter.[6,7]

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