PICC Lines Overview
PICC Lines are Peripherally Inserted Central Catheter lines that are used to provide Vascular Access. Vascular Access can be provided in many ways and this page describes PICC Lines as well as other more and less invasive methods to enable Vascular Access, along with the reasons for using such methods.
PICC Lines, as well as all the other Lines in the illustration, are the most common Lines that Vascular Wellness provides. Vascular Wellness delivers professional nursing services in the Vascular Access specialty at the bedside using the appropriate Vascular Access Device or Central Venous Access Device (VAD). Our nursing specialists (clinicians) provide exceptional Vascular Access insertion, care, maintenance, consulting, and training with the purpose and mission of improving patient outcomes, reducing infections, decreasing infection risk, promoting infection control, preserving vasculature, prioritizing patient safety, empowering nurses, and advancing healthcare. Essentially, we strive to be community partners with our clients and patients.
Vascular Access Lines
PICC Team – Pediatrics
What is a PICC Line and a PICC Team?
A PICC Line is a Peripherally Inserted Central Catheter that extends through the skin to a central vein to provide intravenous therapy. Peripheral veins are those veins in a patient’s arms; in other words, not in the center of the patient’s body. The catheter is inserted into a peripheral vein and then guided to a central vein thus, being referred to as a PICC. However, to the layperson, the term PICC has taken on a more general, non-clinical, meaning to describe the many different procedures and methods to gain Vascular Access. As such, in a non-clinical and non-medical context and while not clinically correct: (a) nurses who perform PICCs and other Vascular Access procedures are often called PICC Nurses or together, a PICC Team, (b) PICC Lines can refer to PICC Lines and any other Vascular Access central catheter or central line, and (c) PICC’s or PICC’s Lines are written even though grammatically incorrect.
What do PICC Nurses or PICC Teams generally do?
PICC Nurses and PICC Teams place PICCs; however, in addition, many PICC Nurses also perform Vascular Access by providing Midlines and Extended and Basic Dwell Peripheral IVs. While Midlines may look like PICCs from the outside, the Midline Catheter is shorter than a PICC Catheter, typically ends near the armpit or axilla and, as a result, does not travel to a central vein. The Extended and Basic Dwell Peripheral IV is even shorter than the Midline Catheter and is inserted into a peripheral vein. Unlike Basic Dwell Peripheral IVs, PICCs, Midlines, and Extended Dwell Peripheral IVs are often inserted and guided to the correct placement using ultrasound machines. PICC Nurses will also maintain lines and ensure that the lines are flowing and not clogged or infected.
What are the main differences among PICCs, Midlines, Extended Dwell Peripheral IVs, and Peripheral IVs?
PICCs, Midlines, Extended Dwell Peripheral IVs, and Peripheral IVs are just some of the options available to obtain Vascular Access. The PICC Nurse will consider the patient’s diagnosis, the patient’s medical history, the type of infusion required including the duration and frequency for such infusion, and the maturity of the patient or caregiver with respect to line maintenance obligations. A PICC is generally used when the IV medications or fluids may irritate veins and such medications need to be given over a longer period of time. A Midline is used when (i) IV medications or fluids that do not irritate veins need to be given over a few weeks, or (ii) typical veins are unavailable, there have been a few unsuccessful attempts at an Extended or Basic Dwell Peripheral IV, or Peripheral IVs simply do not last. An Extended Dwell Peripheral IV is appropriate for (a) IV medications or fluids that do not irritate veins and need to be given over a short period of time and (b) when there is diminished access or there have been unsuccessful attempts at a Peripheral IV. A Peripheral IV (PIV) is appropriate for obtaining lab work and enabling imaging studies such as CT and MRI scans, and the provision of neutral PH IV medications or fluids. In general, PICCs and Midlines have the greatest risk of complications such as bruising, bleeding, infection, infiltration, and blockage, and the PICC Nurse must have the proper skills and experience when performing these procedures.
Patients can be discharged from hospitals with PICCs and Midlines, or PICCs and Midlines can be placed on an outpatient basis, in an outpatient clinic for home health care, and at the patient’s home. In addition, PICCs and Midlines are also often used at Continuing Care Retirement Communities (CCRC) and at senior living facilities. Vascular Wellness places PICCs (single lumen, double lumen, triple lumen and quad lumen catheters) and Midlines (single lumen catheters and, on a limited basis, double lumen catheters) at Hospitals, Surgical Centers, Outpatient Clinics, Senior Communities, Patient’s homes and residences, Hospices, and Prisons and Correctional Facilities. Vascular Wellness clinicians go to the bedside wherever the patient is located to help enable the best possible outcome.
PICC Line Placement X-Ray Confirmation
How do PICC Nurses confirm proper PICC Line Insertion and placement?
With respect to PICCs, Midlines, and Extended Dwell Peripheral IVs, a PICC Nurse will use an ultrasound machine to guide the catheter through the peripheral vein to the proper destination. PICC nurses typically use the Modified Seldinger Technique (MST) to help ensure proper placement. Proper placement can be confirmed by Electrocardiogram (ECG) Tip Confirmation technology or X-Ray, depending on circumstances. Subject to each state’s licensing boards and the skillset of the PICC Nurse, certain PICC Nurses are permitted and competent to read X-Rays to confirm proper PICC Line Insertion and placement. Vascular Wellness clinicians are trained to either use ECG Tip Confirmation or interpret PICC tip location by chest x-ray to ensure placement, allowing immediate use of the Central Line enabling, for example, faster delivery of medications, fluids, or infusions.
What are Small Bore Central Venous Catheters and how do they compare to PICCs?
Small Bore Central Venous Catheters are central lines placed by doctors and a very small subset of PICC Nurses. As these PICC Nurses have the skillset, experience, and permission to place small bore central venous catheters, we refer to them as Vascular Access clinicians. Small bore central venous catheters consist of Axillary, Internal Jugular (IJ) and Femoral Catheters, and if a PICC Line Insertion Site is unavailable, then the progression of central line options escalates in that order. In general, an Axillary Catheter is placed when there is poor vasculature for access in the upper arm. The IJ is a good option when in addition to poor vasculature, the patient has upper arm cellulitis, upper extremity deep vein thrombosis (DVT) or kidney disease. If Axillary and IJ central venous catheter insertion sites are unavailable or the patient has superior vena cava syndrome (SVCS), a block or pinching of the superior vena cave (a major vein that carries blood to the heart), the Vascular Access clinician will insert a Femoral Catheter into the femoral vein ending in the inferior vena cava. These are ultrasound guided placed lines with confirmation of Line insertion and placement by x-ray.
Vascular Access Ultrasound Guided Line Placement with ECG Tip Confirmation
Double Lumen Central Venous Catheter
Can Vascular Access Clinicians place Large Bore Central Venous Catheters?
Vascular Access Clinicians (nurses) can place Large Bore Central Venous Catheters (although few do), and Vascular Wellness performs this Central Venous Catheter Line insertion procedure for patients at the bedside, improving outcomes and reducing costs. These Large Bore Central Venous Catheters are often placed in the Jugular and Femoral Veins and provide rapid fluid and blood administration. In addition to trauma and other uses, they can effectively be used as a temporary central line for Dialysis. Like Small Bore Central Venous Catheters, these are ultrasound guided placed lines with confirmation of Line insertion and placement by x-ray.
How are Vascular Wellness Vascular Access Clinicians different than typical PICC Nurses?
Vascular Wellness’ approach to Vascular Access and the placement of Central Venous Catheter Lines is different from other internal and external Vascular Access providers including PICC Nurses. Vascular Wellness prides itself on being community partners with our clients to deliver the best care to our shared patients. Prior to performing any Vascular Access procedure, the Vascular Wellness clinician reviews the patient’s medical record including history and lab reports, and independently verifies and confirms the doctor’s order. If our clinician disagrees with the prescribing doctor, the clinician will consult with the doctor and they will reach a consensus on treatment. Vascular Wellness’ clinicians actively participate in the Vascular Access treatment. This helps ensure the right Vascular Access device is placed at the right site at the right time enabling for the best clinical outcome for the patient.
Vascular Wellness places and inserts all the basic and advanced non-central Catheter Lines and Central Venous Catheter Lines described above providing our clinicians more tools and capabilities so that the patient gets the right access at the right time. This is very important as Vascular Access lines are not benign, veins are not renewable resources, and vein reservation and preservation can mean not just longer life for the patient but higher quality during those living years. Further, in states where nurses are permitted, Vascular Wellness clinicians can provide immediate X-Ray Clearance of lines when tip confirmation is not available or appropriate and X-Ray confirmation must be used. This saves money, time, and coordination with a Radiologist or other doctor and enables the lines to be used immediately to avoid delaying treatment.
In addition, Vascular Wellness clinicians place and insert PICCs and other Central Venous Catheter Lines in infants and children. Vascular Wellness clinicians work with pediatricians and pediatric departments to provide exceptional care at the bedside. Essentially, Vascular Wellness clinicians place and insert Central Venous Catheter Lines in newborns through the elderly and in patients with special needs including those who are obese, contracted, agitated, dehydrated, or have kidney disease.
Further, Vascular Wellness uses top rated and hospital preferred supplies from Becton Dickinson, formerly Bard (BD). Superior supplies and services help mitigate the potential for poor outcomes such as bad placement, clotting, infections, and other adverse events. This combination of Vascular Wellness clinicians with BD supplies provides an excellent opportunity for a highly successful outcome.
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