A peripherally inserted central catheter (PICC) is a relatively
new form of central line inserted peripherally, threaded into a
central location (Figure 37-1) intended for long-term, including
outpatient, use. It is often used for administration of agents such
as chemotherapeutic drugs, antibiotics, and parenteral nutrition,
and may be associated with a lower rate of infection than centrally inserted
Diagrammatic representation of the course of a PICC.
- ▪ Cephalic vein: travels over the anterior surface of
the bicep muscle
- ▪ Basilic vein: travels along the medial aspect of the biceps
- ▪ Brachial vein: travels along the medial surface of the
- ▪ PICC: PICC line
- ▪ Indications for PICC.
- —Intended long-term need for central access
- —Unavailability of other central sites
- ▪ Contraindications.
- —Infected over or around intended site
- —History of axillary node dissection above intended
- —Radiation above intended site
- —History deep venous thrombosis in veins proximal
to intended site
- —Vascular surgery (ie, dialysis access) proximal
to intended site
- ▪ Prior to procedure, obtain patient consent, prep and
drape, and perform universal protocol as described in Section I.
- ▪ Identify cannulation site based on patient anatomy and
- ▪ Preparation.
- —Skin: The CDC recommends preparation of the
cannulation site with a 2% aqueous chlorhexidine-gluconate
solution (Figure 37-2), which has been associated with lower blood
stream infection rates than povidine-iodine or alcohol-based preparations.
The skin and tissue around the vessel should be infiltrated with
1% lidocaine solution, except in patients with a known
allergy to lidocaine, in whom alternative local anesthetics can
- —Hygiene: The operator should observe proper hand
hygiene and use maximal barrier precautions including gown, mask
and gloves, and a large sterile drape or multiple drapes covering
a large area.
- ▪ Ultrasound (Figures 37-3 and 37-4) is used to identify
a patent peripheral vein.
- ▪ A small bore needle is inserted into the vessel into which
a wire is threaded, followed by a dilator/ tear-away sheath
combination (Figures 37-5, 37-6, 37-7, and 37-8).
- ▪ The dilator is removed from the sheath and the PICC catheter
is threaded over the wire into the central circulation (Figures 37-9, 37-10, and 37-11).
- ▪ The sheath is then peeled away and the wire removed, leaving
the PICC in the vessel alone (Figure 37-12).
- ▪ A chest x-ray is obtained to confirm the central location
of the catheter tip (Figure 37-13).
- ▪ Complications.
- —Catheter occlusion
- —Catheter fracture
Ultrasound probe over antecubital fossa.