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)


Complications of Peripherally Inserted Central Catheter (PICC)


References