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)
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]])
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]