PICC lines

PICC Lines, also known as Peripherally Inserted Central Catheter Lines, are the most common and versatile central lines used to provide Vascular Access. This page describes PICC Line Placement, Insertion, Use, and Risks.

PICC Line

The PICC Line is generally inserted by PICC Nurses or PICC Teams, and these PICC Teams can be internal or external depending on the healthcare provider. Some hospitals augment internal PICC Teams and other hospitals completely outsource their PICC needs. Regardless of the reason, the hospital will outsource to a reputable company of PICC Nurses who are then credentialed for the hospital. Other healthcare providers who have PICC Line needs will also outsource to PICC Nurses as outsourcing is the primary feasible and realistic option.

PICC Line Services

PICC Line Services is a term used often to describe vascular access services of standard lines including Ultrasound Guided PIVs, Midlines, and PICCs. PICC Line Services typically do not include advanced lines such as Small Bore Internal Jugular Lines, Femoral Lines, and Axillary Lines as well as Large Bore Lines including Vas Caths for Dialysis and Quad Lumen Lines. Further, depending on the nursing group, these services generally do not include other more comprehensive areas such as program management, education and training, and infection control consulting, and may not include pediatrics. As stated above, the purpose of this page is to focus on the PICC Line and not the more general, PICC Line Services.

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PICC Line

PICC Line Placement

PICC Line Placement or Procedure

PICC Line Placement generally starts in a vein just above the elbow and weaves around the shoulder to inside the Superior Vena Cava (SVC), a vein just above the heart. The SVC is a large vein that allows caustic medications to be received and diluted before being dispersed into the bloodstream by the heart. An experienced PICC Nurse will not place a PICC Line in the elbow area as such is more prone to bacteria and infection. This procedure holistically includes a review of the patient and the patient’s medical history and records, the actual line placement, and then careful clinical documentation. The PICC Line Procedure and Placement is not clinically appropriate in all cases and when there are contraindications, other central line devices must be considered including advanced lines as described below.

PICC Line Insertion

PICC Line Insertion and guidance of the needle is carefully performed using an ultrasound. The Modified Seldinger Technique (MST) is typically used for correct placement. Some PICC Nurses use needle guides and others, use needle visualization. Needle visualization is preferred and is usually indicative of a clinician with more training and experience and a clinician who is more likely to obtain vascular access in difficult cases. In any case, the line insertion must be confirmed as the PICC is inserted near the heart. PICC Line Insertion can be confirmed via Electrocardiogram (ECG) Tip Confirmation technology or X-Ray, and similar to clinicians who use needle visualization, clinicians who use ECG tend to be the ones with more training and experience. ECG is more convenient and efficient as, when clinically available, it often removes the need to wait for the Xray to be done and evaluated.

PICC Line Uses

PICC Line Use is clinically appropriate as follows:

• pH IV medications or fluids with pH <5 or >9*
• TPN – Total Parenteral Nutrition, a method of getting nutrition into the body through the veins
• CVP – Central Venous Pressure Monitoring, the most accurate blood pressure reading available
• Extended access need > 5 days
• No current Central Venous Line Access (e.g., port, tunneled catheter)
• Current Central Venous Line Access not supportive of expected therapy(s)
*Infusion Nursing Standards of Practice. Journal of Intravenous Nursing, (15) January-February 2011.

In essence, while PICC Line Uses are many, they primarily include when the IV medications or fluids may irritate veins or when medications are to be given over a longer period of time. These medication or fluids include IV antibiotics, chemotherapy, and TPN (Total Parental Nutrition). Furthermore, PICC Lines can have more than 1 lumen (ie, tubing and cap) meaning that they can handle multiple medications with each medication being given in a single lumen to avoid mixing.

PICC Line Risks

PICC Line Risks are present as PICC Line Placement is not a benign procedure. Rather, it is an invasive procedure and as such, prone to risks, some of which are more prevalent than others and all of which are mitigated by the experience of a trained PICC Nurse or clinician. Risks include:

• Central Line Associated Bloodstream Infection (CLABSI) – generally caused by bacteria accessing the body at the insertion site.
• Collapsed Lung (Pneumothorax) – generally caused by the needle piercing the lung, causing the lung to collapse.
• Artery Puncture – generally caused by the needle puncturing the artery instead of the vein, potentially causing a hematoma due to blood collecting outside the artery.
• Nerve or Vein Injury – generally caused by the needle hitting the nerve or vein during insertion.
• Blood Clot or DVT – direct causes are not well documented, but one cause can be when the catheter takes up too much space in the vein.
• Air Embolism – generally caused by air entering the vein during needle insertion.

While these and other risks must be considered, the PICC Line is still the most clinically appropriate central line access in many situations.

Small Bore Lines

Small Bore Lines including Internal Jugular Lines, Femoral Lines, and Axillary Lines provide the next options for vascular access. Vascular Wellness places Axillary Lines; although, they are used much less frequently than Internal Jugular Lines and Femoral Lines.  Small Bore Lines are just some of the many ways Vascular Wellness provides the most comprehensive vascular access services.

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We offer timely, innovative, and advanced vascular access services at the bedside, with full administrative support, from skilled employees who care.

Want more than just a PICC Service or PICC Team?
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Vascular Wellnesssm provides clinical vascular access nursing services at the bedside across the Southeast to a diverse client base including Tertiary Hospitals, Community Hospitals, Long Term Acute Care Hospitals, Skilled Nursing Facilities, Surgical and Outpatient Centers,  Hospice, and At-Home care.

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