Peripherally Inserted Central Catheter (PICC)

Indications

Need for Central Venous Access

Need for Central Venous Pressure (CVP) Measurement (see Hemodynamics, [[Hemodynamics]])

  • General Comments
    • PICC lines have longer length and narrower lumen than CVC’s -> PICC has higher intrinsic resistance than CVC
    • CVP monitoring is an indicated use by several commercially available PICC’s (AngioDynamics, Arrow, Bard, Medcomp)
  • Early Study Comparing CVP Obtained from CVC and PICC Lines (Crit Care Med, 2000) [MEDLINE]
    • Study: 77 data pairs from 12 patients with measurements recorded at end-expiration in 19-gauge double-lumen PICC’s (zeroed at right atrium)
      • PICC’s used in this study did not have high infusion rate capability
      • To overcome the higher inherent resistance of the PICC, a continuous infusion device was used with heparinized saline at 3 mL/hr (as in arterial lines)
    • Main Findings: CVP recorded from a PICC line is about 1 mm Hg higher than CVP recorded from a CVC (this difference is believed to be clinically insignificant) -> PICC lines can be used to measure CVP, provided that continuous infusion device is used with heparinized saline
  • Operative Study During AAA Repair Comparing CVP Obtained from CVC and PICC Lines (Ann Vasc Surg, 2006) [MEDLINE]
    • Main Findings: PICCs are an effective method for CVP monitoring in situations of dynamic systemic compliance and preload, such as during elective AAA repair
  • In Vitro Study Comparing CVP Obtained from CVC and PICC Lines (BMC Anesthesiol, 2010) [MEDLINE]
    • Study: in vitro study of AngioDynamics Morpheus PICC
      • Unlike other PICC models, the Morpheus PICC shaft has a stiff proximal end with a softer distal end: stiff proximal end decreases intraluminal resistance, prevents compression by soft tissues prior to vessel entry, and prevents compression of catheter in region of the subclavian vein (which is a known compression site for vascular catheters)
    • Main Findings: PICC was equivalent to CVC when measuring CVP
  • Korean Study Utilizing PICC and CVP Measurements During Liver Transplantation (Korean J Anesthesiol, 2011) [MEDLINE]
    • Study: double-lumen Arrow PICC
    • Main Findings: PICC was a viable alternative to CVC for CVP measurement during liver transplantation
  • In Vitro and In Vivo Study Comparing CVP Obtained from CVC and PICC Lines (J Clin Monit Comput, 2012) [MEDLINE]
    • Study: used triple and double-lumen Bard PowerPICC’s (with high infusion rate capability) vs CVC in in vitro (540 pressure measurements) and in vivo (70 pressure measurements) protocols
    • Main Findings: PICC was equivalent to CVC when measuring CVP in ICU patients

Advantages of Peripherally Inserted Central Catheter (PICC)

  • No Risk of Pneumothorax (Due to Upper Extremity Insertion Site with No Need to Puncture Near Lung)
  • Minimal Risk of Hemorrhage (Due to Upper Extremity Insertion Site with No Need to Puncture Near Large Vessels

Complications of Peripherally Inserted Central Catheter (PICC)

  • Catheter-Associated Bloodstream Infection (CLABSI)
    • Systematic Review/Meta-Analysis Comparing PICC vs CVC Infection Rates (Infect Control Hosp Epidemiol, 2013) [MEDLINE]
      • Outpatients: PICC has lower CLABSI rate than CVC
      • Inpatients: PICC and CVC probably have comparable CLABSI rates
  • PICC Line Malposition
    • PICC Position Can Be Assessed Using Ultrasound of the Ipsilateral Neck (Crit Care Med, 2009) [MEDLINE]: this may allow proper repositioning of the PICC during the initial placement
  • Superficial Venous Thrombosis (SVT)/Deep Venous Thrombosis (DVT) (see Deep Venous Thrombosis, [[Deep Venous Thrombosis]])
    • Trial Examining PICC Line-Associated Thrombosis Rates (J Vasc Interv Radiol, 2000) [MEDLINE]
      • Venous thrombosis rate was 3.9% with PICC lines
    • Meta-Analysis Comparing PICC Line with Central Venous Catheter (Lancet, 2013) [MEDLINE]
      • PICC lines had a higher risk of venous thrombosis than central venous catheters, especially in patients who are critically ill or those with cancer
      • PICC lines had no risk of acute PE

References

  • It’s all about PICCs: optimal catheter and vein selection prove vital to patient safety intiatives. http://www. nursingmanagement.com
  • Peripherally inserted central catheters in an acute-care hospital. Arch Intern Med. 1994;154:1833–7
  • Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 2000;11(2000):837-840 [MEDLINE]
  • Central venous pressure measurements: peripherally inserted catheters versus centrally inserted catheters. Crit Care Med. 2000 Dec;28(12):3833-6 [MEDLINE]
  • Complications of central venous catheters: internal jugular versus subclavian access—a systematic review. Crit Care Med. 2002;30(2):454–60
  • Preventing complications of central venous catheterization. N Engl J Med. 2003;348(12):1123–33
  • Risk of catheter-related bloodstream infec- tion with peripherally inserted central venous catheters used in hospitalized patients. Chest. 2005;128(2):489–95
  • Intraoperative peripherally inserted central venous catheter central venous pressure moni- toring in abdominal aortic aneurysm reconstruction. Ann Vasc Surg. 2006;20:577–81
  • Intraoperative peripherally inserted central venous catheter central venous pressure monitoring in abdominal aortic aneurysm reconstruction. Ann Vasc Surg. 2006 Sep;20(5):577-81. Epub 2006 Jul 27 [MEDLINE]
  • Peripherally inserted central catheter use in the hospitalized patient: is there a role for the hospitalist? J Hosp Med. 2009;4(6):E1–4 [MEDLINE]
  • A randomized, controlled trial evaluating postinsertion neck ultrasound in peripherally inserted central catheter procedures.  Crit Care Med  2009; 37:1217-1221 [MEDLINE]
  • Peripherally inserted central venous catheters in the acute care setting: a safealternative to high-risk short-term central venous catheters. Am J Infect Control. 2010;38(2):149–53
  • An in vitro study comparing a peripherally inserted central catheter to a conventional central venous catheter: no difference in static and dynamic pressure transmission. BMC Anesthesiol. 2010;10(18): 1–7
  • Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res. 2010; 31(1):31–5. doi:10.1097/BCR.0b013e3181cb8eaa
  • An in vitro study comparing a peripherally inserted central catheter to a conventional central venous catheter: no difference in static and dynamic pressure transmission. BMC Anesthesiol. 2010 Oct 12;10:18. doi: 10.1186/1471-2253-10-18 [MEDLINE]
  • Comparison of the central venous pressure from internal jugular vein and the pressure measured from the peripherally inserted antecubital central catheter (PICCP) in liver transplantation recipients. Korean J Anesthesiol. Oct 2011; 61(4): 281–287. Published online Oct 22, 2011. doi: 10.4097/kjae.2011.61.4.281 [MEDLINE]
  • Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring. J Clin Monit Comput. 2012 Apr;26(2):85-90. doi: 10.1007/s10877-012-9337-1 [MEDLINE]
  • Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013;382(9889):311-325 [MEDLINE]
  • The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):908-18. doi: 10.1086/671737. Epub 2013 Jul 26 [MEDLINE]
  • Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access. 2014 Sep-Oct;15(5):329-37. doi: 10.5301/jva.5000239. Epub 2014 Apr 25 [MEDLINE]