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

Contraindications

Several factors contraindicate PICC placement: lack of peripheral access, venous thrombosis, and end-stage renal disease. In addition, PICCs should not be used for frequent intermittent access or for blood sampling.

Patients with restricted peripheral access must be sent to the interventional radiology department to have PICC placement performed under fluoroscopy. These patients also may be referred to a facility that uses the modified-Seldinger technique with ultrasound for bedside PICC placement. Sometimes, a patient may not have an accessible peripheral vein, even when ultrasound is used. This patient will require a different type of central catheter.

The presence of upper extremity or subclavian thrombosis is another contraindication for bedside PICC insertion, whether or not ultrasound is used. These patients also may be referred to interventional radiology to have a PICC inserted under fluoroscopy.

Patients with chronic renal failure and end-stage renal disease are not appropriate candidates for PICC placement. The need to preserve peripheral veins for future dialysis fistulas is a critical issue for these patients. Insertion of any catheter in the upper extremity or the subclavian veins can cause thrombus formation and scarring that could reduce the probability for successful fistula development. The internal jugular vein, particularly the right jugular vein, is the preferred insertion site for these patients. Although this choice is not without risks, it provides the straightest and shortest route to the superior vena cava and minimizes potential venous damage.[17]

Insertion of any central VAD must be performed judiciously, as every insertion increases the risk of vessel damage, thrombosis, and stenosis, and potentially creates difficulty in obtaining future access. PICC insertion often becomes difficult or impossible for patients who have had multiple previous PICCs. If a patient requires frequent intermittent access, an implanted venous port may be a better choice.

Because a PICC is very long and thin, it is not advisable to insert it solely for the purpose of obtaining blood for laboratory analysis. Each blood draw increases the risk of occluding the catheter. A risk-benefit analysis should be done to determine the value of using a PICC for drawing blood. Manufacturers' directions for use should be consulted carefully when making this decision.

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