Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older
CPT4 code
Name of the Procedure:
Insertion of Peripherally Inserted Central Venous Catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older.
Summary
A PICC line is a long, thin tube inserted into a vein in the arm and directed toward a larger vein near the heart. This type of catheter provides access to the central veins without the need for imaging guidance.
Purpose
This procedure addresses the need for long-term intravenous (IV) access. It is used for delivering medications, fluids, or obtaining blood samples frequently. The goal is to facilitate safe and reliable access to central veins while minimizing patient discomfort and reducing the frequency of needle sticks.
Indications
- Long-term medication administration (e.g., antibiotics, chemotherapy)
- Frequent blood sampling
- Total parenteral nutrition (TPN)
- Patients with difficult peripheral venous access
Preparation
- Follow fasting instructions if advised by the healthcare provider.
- Inform the doctor of all medications and supplements currently being taken.
- Laboratory tests including blood work may be needed to ensure it's safe to proceed.
Procedure Description
- Patient Positioning: The patient lies flat on a clean, sterile surface.
- Site Selection: A suitable vein in the arm is identified.
- Sterile Preparation: The area is cleaned and disinfected.
- Local Anesthesia: Local anesthetic is administered to numb the insertion site.
- Catheter Insertion: The catheter is gently inserted through the arm vein and navigated towards the central veins near the heart, without the use of imaging guidance.
- Securing the Catheter: The catheter is secured in place with adhesive strips or sutures.
- Final Checks: The functionality is confirmed by drawing blood or flushing with saline.
Tools and Equipment
- Sterile gown and gloves
- Antiseptic solution
- Local anesthetic
- PICC line catheter and insertion kit
- Adhesive dressings
Duration
The procedure typically takes about 30 minutes to 1 hour to complete.
Setting
Can be performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Trained nurse or physician (often a radiologist or specialized nurse)
- Assisting nurse
Risks and Complications
- Infection at the insertion site
- Blood clots
- Catheter misplacement
- Vein damage
- Air embolism
Benefits
- Reliable and long-term vein access
- Reduced need for multiple needle sticks
- Effective delivery of necessary medications and nutrition
- Generally, effective immediately post-procedure
Recovery
Post-procedure instructions include:
- Keeping the insertion site dry and clean
- Monitoring for signs of infection
- Regularly scheduled dressing changes
- Follow-up appointments to monitor catheter position and function
Alternatives
- Peripheral IV line: Less invasive but suitable only for short-term use.
- Central venous catheter (CVC): Requires imaging guidance and is more invasive.
- Subcutaneous port: More invasive but can be beneficial for certain patient needs.
Patient Experience
Patients might feel initial discomfort from the needle stick during local anesthesia administration. After the anesthetic, they should feel minimal pain. Post-procedure, patients might experience mild soreness at the insertion site. Pain management includes over-the-counter pain relief medications and proper site care instructions.