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

Patient Assessment

An assessment should be done as early as possible during a patient's hospital admission, in order to determine the type of VAD that is most appropriate for the therapy type and duration, condition of veins, and diagnosis. The most appropriate device will provide access throughout the course of therapy, minimize pain and venous damage, use nursing time efficiently, and be cost effective. Assessment should be done upon admission even though the patient's diagnosis and eventual course of therapy may not yet be determined.

For example, if a patient is admitted with a tentative diagnosis of methicillin-resistant Staphylococcus aureus, and empiric vancomycin therapy is initiated, the first several doses may be administered via short peripheral intravenous cannulas. It may be premature to insert a PICC on the first day of therapy when culture and susceptibility results are not yet available. A PICC can be inserted once the need for longer-term vancomycin therapy is clear. Frequent or unnecessary central venous catheter insertions should be avoided, as this exposes the patient to potential risks such as thrombosis and stenosis of the vessels leading to the superior vena cava, and may make it more difficult or impossible to advance a catheter through that vessel in the future.

The choice of VAD should reflect the expected duration of a patient's intravenous therapy. "Dwell time" is the maximum expected duration considered appropriate for a given type of device. However, many devices have no established dwell time. Nontunneled percutaneous central venous catheters, such as internal jugular, subclavian, and femoral devices, are generally considered appropriate only for short-term use, due to the higher risk of infection compared with PICCs, implanted ports, and tunneled catheters. There is no established dwell time for PICCs,[1] but if the therapy is expected to last longer than 1 year, a more permanent type of central access device should be considered, such as a tunneled catheter or implanted port.

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