How to insert a PICC: practical tips for the intensive care physician
DOI:
https://doi.org/10.33393/ao.2022.2360Keywords:
CICC, Intensive Care, Occasional, PICCAbstract
Peripherally inserted central catheters (PICCs) are central vascular access devices inserted via deep veins of the arm, also useful in critical care settings. The purpose of this article is to offer to a critical care clinician with good skills in central venous catheterization, but who has limited experience on PICC catheters, the basic information on how the procedure is performed and how to minimize the risks of complications or failure of the maneuver.
The main technical steps and the main precautions to be taken during PICC placement will be analyzed, with reference to the differences compared to central catheterization. Specifically, the pre-procedural phase and the intraprocedural main steps of the maneuver will be analyzed.
A dedicated Vascular Access Team is considered useful and desirable by the current literature, but when the use of the PICC proves useful or even mandatory, the intensive care physician skilled in central venous catheters can transfer skills from central to peripheral catheterization.
Downloads
References
Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice. 8th ed. J Infus Nurs. 2021 Jan-Feb 01;44(1S Suppl 1):S1-S224. https://doi.org/10.1097/nan.0000000000000396 PMID: 33394637. DOI: https://doi.org/10.1097/NAN.0000000000000396
Chopra V, O’Horo JC, Rogers MA, Maki DG, Safdar N. 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;34(9):908-918. https://doi.org/10.1086/671737 PMID:23917904 DOI: https://doi.org/10.1086/671737
Pittiruti M, Pinelli F; GAVeCeLT Working Group for Vascular Access in COVID-19. Recommendations for the use of vascular access in the COVID-19 patients: an Italian perspective. Crit Care. 2020;24(1):269. https://doi.org/10.1186/s13054-020-02997-1 PMID:32466803 DOI: https://doi.org/10.1186/s13054-020-02997-1
Marschall J, Mermel LA, Fakih M, et al; Society for Healthcare Epidemiology of America. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753-771. https://doi.org/10.1086/676533PMID:24915204 DOI: https://doi.org/10.1086/676533
O’Grady NP, Alexander M, Burns LA, et al; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193. https://doi.org/10.1093/cid/cir257 PMID:21460264 DOI: https://doi.org/10.1093/cid/cir257
Chun TT, Judelson DR, Rigberg D, et al. Managing central venous access during a health care crisis. J Vasc Surg. 2020;72(4):1184-1195.e3. https://doi.org/10.1016/j.jvs.2020.06.112PMID:32682063
Emoli A, Cappuccio S, Marche B, Musarò A, Scoppettuolo G, Pittiruti M; Gruppo Aperto di Studio sugli Accessi Venosi Centrali a Lungo Termine. The ISP (Safe Insertion of PICCs) protocol: a bundle of 8 recommendations to minimize the complications related to the peripherally inserted central venous catheters (PICC). Assist Inferm Ric. 2014;33(2):82-89. PMID:25002059
Lamperti M, Biasucci DG, Disma N, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol. 2020;37(5):344-376. https://doi.org/10.1097/EJA.0000000000001180PMID:32265391 DOI: https://doi.org/10.1097/EJA.0000000000001180
Dawson R. PICC Zone Insertion Method™ (ZIM™): a systematic approach to determine the ideal insertion site for PICCs in the upper arm. J Assoc Vasc Access. 2011;16(3):156-165. https://doi.org/10.2309/java.16-3-5 DOI: https://doi.org/10.2309/java.16-3-5
Sharp R, Cummings M, Fielder A, Mikocka-Walus A, Grech C, Esterman A. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud. 2015;52(3):677-685. https://doi.org/10.1016/j.ijnurstu.2014.12.002 PMID:25593110 DOI: https://doi.org/10.1016/j.ijnurstu.2014.12.002
Elli S, Bellani G, Cannizzo L, et al. Reliability of cutaneous landmarks for the catheter length assessment during peripherally inserted central catheter insertion: A retrospective observational study. J Vasc Access. 2020;21(6):917-922. https://doi.org/10.1177/1129729820911225PMID:32228229 DOI: https://doi.org/10.1177/1129729820911225
Elli S, Cannizzo L, Marini A, et al. Evaluation of tip location reliability of intraprocedural ECG vs. chest Xrays in PICC placement. Assist Inferm Ric. 2016 Oct-Dec;35(4):174-179. https://doi.org/10.1702/2621.26950. PMID: 28151509.
Greca A, Iacobone E, Elisei D, et al. ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients. J Vasc Access. 2021. https://doi.org/10.1177/11297298211044325 PMID:34494474 DOI: https://doi.org/10.1177/11297298211044325
Chopra V, Flanders SA, Saint S, et al; Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) Panel. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results from a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015;163(6)(suppl):S1-S40. https://doi.org/10.7326/M15-0744PMID:26369828 DOI: https://doi.org/10.7326/M15-0744
Pinelli F, Pittiruti M, Van Boxtel T, et al. GAVeCeLT-WoCoVA Consensus on subcutaneously anchored securement devices for the securement of venous catheters: current evidence and recommendations for future research. J Vasc Access. 2021;22(5):716-725. https://doi.org/10.1177/1129729820924568 PMID:32613887 DOI: https://doi.org/10.1177/1129729820924568
Zerla PA, Canelli A, Cerne L, et al. Evaluating safety, efficacy, and cost-effectiveness of PICC securement by subcutaneously anchored stabilization device. J Vasc Access. 2017;18(3):238-242. https://doi.org/10.5301/jva.5000655 PMID:28218360 DOI: https://doi.org/10.5301/jva.5000655
Scoppettuolo G, Dolcetti L, Emoli A, La Greca A, Biasucci DG, Pittiruti M. Further benefits of cyanoacrylate glue for central venous catheterisation. Anaesthesia. 2015;70(6):758. PMID:25959189 https://doi.org/10.1111/anae.13105 PMID:25959189 DOI: https://doi.org/10.1111/anae.13105
Published
How to Cite
License
Copyright (c) 2021 Stefano Elli, Giacomo Bellani, Alberto Lucchini
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2022-03-21
Published 2021-04-11
