Name of the Procedure:

Insertion of Peripherally Inserted Central Venous Catheter (PICC), without Subcutaneous Port or Pump, with Imaging Guidance

Summary

A Peripherally Inserted Central Catheter (PICC) is a long, thin tube inserted through a vein in your arm and guided to the central veins near your heart. This procedure uses imaging technologies, such as ultrasound and X-rays, to ensure correct placement of the catheter.

Purpose

The PICC line is used for long-term intravenous access to deliver medications, nutrients, or to draw blood samples. It is commonly indicated for patients requiring lengthy treatments like chemotherapy, extended antibiotic courses, or total parenteral nutrition (TPN).

Indications

• Long-term intravenous (IV) therapy
• Chemotherapy
• Extended antibiotic treatment
• Total parenteral nutrition (TPN)
• Need for frequent blood draws

Preparation

• Patients may need to avoid eating or drinking for a few hours before the procedure.
• Certain medications may need to be adjusted; this should be discussed with the healthcare provider.
• Blood tests or imaging studies may be required beforehand to assess vein health and coagulation status.

Procedure Description

1. Patient Positioning: The patient lies on their back with the arm extended.
2. Site Selection and Preparation: The insertion site is cleaned and sterilized.
3. Local Anesthesia: Local anesthesia is administered to numb the insertion area.
4. Insertion: Using ultrasound guidance, the catheter is inserted into a vein in the arm.
5. Advancing the Catheter: The catheter is carefully advanced through the vein to the central veins near the heart.
6. Confirmation: X-ray imaging is used to confirm the catheter's correct position.
7. Securement: The catheter is secured in place with a dressing to prevent movement.

Duration

The procedure typically takes about 1 to 2 hours to complete.

Setting

PICC line insertion is usually performed in a hospital, outpatient clinic, or a dedicated vascular access center.

Personnel

• Interventional radiologist or specialized nurse
• Radiologic technologist
• Nursing staff

Risks and Complications

• Infection at the insertion site
• Bleeding or bruising
• Vein irritation or inflammation (phlebitis)
• Catheter migration or misplacement
• Blood clots
• Rarely, air embolism

Benefits

• Provides reliable intravenous access for long-term treatments.
• Reduces the need for multiple needle sticks.
• Allows for the administration of medications that can’t be taken orally or injected into smaller veins.

Recovery

• Patients can often go home the same day.
• Keep the insertion site clean and dry.
• Avoid heavy lifting or strenuous activity with the affected arm.
• Follow-up appointments may be necessary for dressing changes and to check catheter function.

Alternatives

• Peripheral IV lines: Short-term and may need frequent replacement.
• Central venous catheters (CVC): More invasive and often require surgical placement.
• Implanted ports: Placed under the skin and accessed with a needle, suitable for very long-term use.

Patient Experience

• Slight discomfort or pressure during the insertion.
• Postsurgical instructions include how to care for the insertion site and any activity restrictions.
• Pain is usually minimal and manageable with over-the-counter pain relievers.