PIC Line

PIC LinePIC Line (or PICC)–A peripherally inserted central catheter (PICC or PIC line) is a form of intravenous access that can be used for a prolonged period of time (e.g. for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition).  First described in 1975, it is an alternative to subclavian lines, internal jugular lines or femoral lines which have higher rates of infection.  Subclavian and internal jugular line placements may result in pneumothorax (air in the pleural space of lung).

A PICC is inserted in a peripheral vein, such as the cephalic vein, basilic vein, or brachial vein and then advanced through increasingly larger veins, toward the heart until the tip rests in the distal superior vena cava or cavoatrial junction.

PICCs are usually inserted by physicians, physician assistants (in the USA), radiologist assistants (in the USA), nurse practitioners, or specially trained certified registered nurses and radiologic technologists using ultrasound, chest radiographs, and fluoroscopy to aid in their insertion and to confirm placement. PICC insertion is a sterile procedure, but does not require the use of an operating room. When done at bedside (that is, in the patient’s room), a suitable sterile field must be established and maintained throughout the procedure. For this reason, visitors are normally requested to leave the room until the insertion is complete and some form of skin preparation should be used to clean patient skin.

The insertable portion of a PICC varies from 25 to 60 centimeters in length, that being adequate to reach the desired tip position in most patients. Some lines are designed to be trimmed to the desired length before insertion, others are simply inserted to the needed depth with the excess left outside. As supplied, the line has a guide wire inside. This wire is provided to stiffen the (otherwise very flexible) line so it can be threaded through the veins. The wire is removed and discarded after insertion.

The PICC is also provided with a “wing” having holes for either sutures or an adhesive securement device such as Statlock. Other new technologies which may provide advantages are being introduced to the market such as the SecurAcath subcutaneous securement technology. Securing the catheter prevents post-insertion movement of the line, as that could place the tip in an unsafe position.

Removal of a PICC line is a considerably more simple procedure in most cases. Generally, the catheter line can be safely and quickly removed by a trained nurse, even in the patient’s own home, in a matter of minutes. After removal, the insertion site is normally bandaged with sterile gauze and kept dry for a few days, during which the wound can close and begin healing. Usually, a smaller adhesive bandage can be placed over the wound site after the gauze is removed if the wound is slow to heal.

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