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

Insertion Methods

There are 2 methods of bedside PICC insertion: the peel-away cannula technique and the modified-Seldinger technique.

With the traditional peel-away cannula technique, access is established by inserting the cannula and stylet, much like a regular intravenous cannula, into a palpable vein in or near the antecubital fossa. The stylet is removed and the catheter inserted through the cannula. The cannula is then pulled back and peeled away from the catheter. This technique requires accessible veins at or near the antecubital fossa. It also has a higher incidence of thrombophlebitis than the modified-Seldinger technique.

With the modified-Seldinger technique, a vein is accessed with a regular hypodermic needle, an intravenous cannula, or an echogenic needle. A guide wire is threaded into the needle or cannula several centimeters, then the needle or cannula is removed, leaving the guide wire in place. The guide wire is not advanced past the shoulder. A nick is made in the skin beside the guide wire, and an introducer sheath with dilator is inserted over the guide wire. The guide wire and dilator are removed, and the catheter is advanced through the introducer sheath, which is then pulled back and peeled away.

When using the second technique, it is possible to use ultrasound to locate and help access the vein, increasing the insertion success rate. Ultrasound also facilitates access of larger veins higher in the upper arm. Upper arm insertions have been associated with a lower incidence of thrombosis, phlebitis and catheter migration than antecubital fossa insertions.[11,12,13,14,15]

Either insertion method requires maximal sterile barrier precautions to reduce the risk of contamination and subsequent catheter-related bloodstream infections. Maximal sterile barrier precautions include the use of a mask, sterile gown, hair cover, sterile gloves, and large sterile drapes.[1,6,10,16]

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