ACCESS
PERIPHERALLY INSERTED CENTRAL CATHETER
Introduction
Last updated: apr 5, 2023
The ability to obtain venous access in the inpatient and outpatient setting is one of the most fundamental, yet, crucial components for a large number of diagnostic and therapeutic interventions. It is especially vital for critically ill patients who often require frequent blood sampling, vasoactive medications, rapid fluid resuscitation, prolonged antibiotic administration and various other indications. Venous access can be obtained through conventional peripheral intravenous (IV) lines, midline peripheral catheters, and central venous catheters (CVCs).
Peripherally inserted central catheters (PICCs) are a subset of central venous catheters. They are 50 cm to 60 cm long single, double or triple lumen catheters that are placed in a peripheral arm vein and terminate in the thorax. They can be used for medium-term venous access, which is defined as anywhere between several weeks to 6 months.
Indications
- Bij medicatie welke de vaatwand irriteert
- Bij langdurige therapie (>1 week)
- Bij slechte perifere toegang
Bij een PICC ligt de tip centraal bij de cavo-artiale overgang, waar de flow zo'n 2 l/m is. Hierdoor verdunt het toegediende momentaan en wordt voorkomen dat de vaatwand beschadigd wordt.
The procedure in steps
- TOP
- Apply the tourniquet
- Disinfect with chlorhexidine
- Place drape
- Wrap the ultrasound machine
- Sterile wrap the X-ray tube and bring it nearby
- Prepare the guidewire and place it on the patient
- Subcutaneous anesthesia under ultrasound guidance
- Tighten the tourniquet
- Make an incision in the skin (needed for SecurAcath)
- Puncture under ultrasound guidance
- Advance the guidewire into the vessel
- Release the tourniquet
- Advance the guidewire further under fluoroscopic guidance
- Position the tip of the guidewire at the cavo-atrial junction
- Remove the needle
- Measure the length on the skin
- Cut the catheter to size
- Insert the introducer
- Remove the core of the introducer
- Advance the catheter over the guidewire
- Check position (without the guidewire protruding)
- Take an X-ray
- Remove the introducer by splitting it
- Advance the guidewire again so it protrudes from the line
- Advance the PICC line as far as possible
- Remove the guidewire
- Apply fixation with the Securacath
- Flush the lumen with NaCl/Heparin
- Cap the PICC line
- Apply Tegaderm
- Place Elastofix (elastic netting) around the arm
- Document nursing handover in Hix under “post-procedure care”
- Draft preliminary report in RIS under “study information”
- SOP
Report
Time-out akkoord. Wassen met chloorhexidine en steriel afdekken. Echografisch onderzoek van de vena basilica rechts toont geen stenose of occlusie. Onder echogeleide aanprikken van de vene. Enkel lumen PICC van 35 cm lengte “over-the-wire” geplaatst, met de tip bij cavo-atriale overgang. Goed door te spuiten. Procedure zonder complicaties verlopen. Fixatie met SecurAcath.
