Chapter 17: Vascular access devices: insertion and management
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Peripherally inserted central catheters
Definition
A peripherally inserted central catheter (PICC) is a catheter that is inserted percutaneously via the veins in the arm and advanced into the central veins, with the tip located in the superior vena cava (SVC) (usually the lower third) or cavo‐atrial junction (Gorski et al. [181], Hadaway [194], Nakazawa [342], RCN [381]). It is not to be confused with a mid‐clavicular catheter (often referred to as a ‘long line’), where the tip is located in a central vein leading to the SVC, such as the subclavian or proximal axillary vein (Carlson [62], Dougherty [123]). Because of the increasing evidence that mid‐clavicular catheters are associated with a high incidence of thrombotic complications (up to 60%), mid‐clavicular placement should only be considered if there are anatomical or pathophysiological reasons, for example SVC syndrome (Carlson [62], Gallieni et al. [164]).
PICCs have been a popular vascular access device (VAD) since the early 1990s in both, adults and children. They can deliver drugs, liquids or parenteral nutrition via a central vein with the safety of conventional peripheral venous access. Therefore, PICCs can be considered as a hybrid of conventional peripheral venous access devices and central venous catheters (Mussa [341]).