Makindo Medical Notes

Related Subjects: |Malnutrition universal screening tool (MUST) |Body Mass Index |Peripherally inserted central catheters (PICC)

Introduction

• The (PICC) is a long, thin, flexible tube inserted into a large vein in the arm
• The tip positioned in the superior vena cava (SVC).
• PICC lines can be managed in an outpatient setting
• They can remain in place for up to a year, provided there are no complications.

Precautions

• Only competent staff, or staff-in-training supervised by experienced personnel, should perform this procedure

Indications

• Administration of chemotherapy, antibiotics, or intravenous (IV) fluids.
• Delivery of total parenteral nutrition (TPN).

Benefits of PICC Line

• Eliminates the risk of pneumothorax associated with central venous catheterization via the neck or chest.
• PICC lines can remain functional for several months, making them ideal for long-term treatment.
• Lower risk of infection and sepsis compared to other central venous access devices.

Potential Complications

• Local venous thrombosis: Manifests as swelling, pain, or tenderness in the affected limb.
• Sepsis or line infection: Symptoms include fever, redness, pain, or discharge at the insertion site.
• Nerve injury, bleeding, or catheter blockage: These complications may occur during insertion or use.

PICC Line Care Instructions

• Always wash your hands before touching the PICC line to maintain hygiene and prevent infection. Keep the dressing and insertion site dry.
• Only change dressings after proper training and follow strict aseptic techniques. Seek medical help if there are any signs of infection such as discharge, redness, swelling, or pain at the insertion site.
• Flushing the line: Clean the catheter caps with alcohol swabs before and after each use. The PICC line should be flushed every 12 hours or after each use with 10 ml of 0.9% normal saline.
• Close the catheter clamp when not in use. If no clamps are present, the PICC line is a "saline only" line, and no Heparin flush is required after the saline flush.
• Avoid taking blood pressure measurements in the arm with the PICC line to prevent damage.
• Normal use of the arm with the PICC line is encouraged to increase circulation, but avoid pulling or tugging on the catheter.

PICC Line Insertion Procedure

• Don personal protective equipment (PPE), including a plastic apron and protective eyewear if necessary. Apply a tourniquet, select a suitable vein, and palpate the vein. Release the tourniquet after vein selection.
• Wash hands and forearms thoroughly with soap and water or an antiseptic solution. Prepare an aseptic field with a sterile dressing and equipment pack. Clip hair around the insertion site if necessary.
• Prepare the insertion site with a solution of 1-2% chlorhexidine gluconate (CHG) in 70% ethyl or isopropyl alcohol. Apply the solution in a circular motion starting from the center of the site, extending outward for at least 30 seconds.
• Allow the skin preparation to dry, then reapply the tourniquet. Put on clean, non-sterile gloves and drape the insertion site with a sterile towel.
• Using an aseptic technique, insert the catheter into the selected vein. After insertion, secure the catheter with a transparent dressing and sterile adhesive tape or adhesive wound closure strips to prevent dislodgement.
• Record the insertion details on the dressing and in the patient's chart for accurate documentation.

Post-Insertion Care

• Perform a chest X-ray (CXR) to confirm the correct position of the PICC line in the superior vena cava.
• Ensure the line is securely in place. Sutures are avoided to reduce infection risks; secure the line with appropriate adhesive devices or dressings.