PERIPHERALLY INSERTED CENTRAL CATHETER

 A Peripherally Inserted Central Catheter (PICC) is a small gauge catheter that

is inserted in a peripheral vein in the arm, such as the cephalic vein, basilic vein
or brachial vein, and then advanced proximally toward the heart trough
increasingly larger veins, until. the tip rests in the distal vena cava or large vein in
your chest (Superior Vena Cava).
 For placement in the superior vena cava, measure the distance from the insertion
site to the shoulder and from the shoulder to the sternal notch, then add 3” (7,6
cm) to the measurement.
 PICC is used to give IV fluids, Blood Transfusions, Chemotherapy, and
administration of any drugs.
 Many intravenous medications and solutions cause damage to the peripheral
venous endothelium and should be administered centrally to avoid this damage.
 PICC insertion is a sterile procedure, but does not require the use of an operating
room. When done at bedside (patient’s room), a suitable sterile field must be
established and maintained throughout the procedure.
 A Peripherally Inserted Central Catheter may stay in place for weeks or months
and helps avoid the need for repeated needle sticks.

INDICATIONS
PICC lines are suitable for many situations when access is limited or expected to the
last longer than 2 weeks and also allows for easy blood draws where appropriate
indications include:
 Compromised/inadequate peripheral access
 Infusion of hyperosmolar solutions with high acidity or alkalinity (e.g. Total
Parenteral Nutrition’s)
 Infusion of vesicant or irritant agents (chemotherapy)
 Short- or long-term intravenous therapy (e.g. Antibiotics)

CONTRAINDICATIONS
 Previous upper extremity venous thrombosis (DVT).
 Trauma or vascular surgeries at or near the site of insertion.
 Presence of a device related infection or bacteremia at or near the insertion site.
 Lymphedema
 Allergy to materials.

CAUTIONS
 Always use aseptic techniques during catheter and use.
 Never leave the catheter uncapped. Always apply sterile cap.
 Never use acetone or taper remover on or near the catheter; these can dissolve
the catheter.
 Blood pressure measurements should be avoided on limbs with PICCs.

DAILY ASSESSMENTS
 1. Assess insertion site for bleeding, exudate, leakage, redness.
a. Upper limbs should be compared for temperature and edema when PICCs.
2. Assess catheter tubing assess for migration, malposition, kinks and cracks.
3. Assess dressing. Inspect that the securement and dressing is dry and intact and
the change due date is clearly visible.

POSSIBLE PROBLEMS
 You may get infection
 The line may get blocked
 A blood clot can develop
 A PICC line may split.

The line is flushed regularly with heparin or salt water (saline) to clean the line and
prevent clotting.

REMOVAL OF PICC
 In most cases the removal of PICC is a simple procedure. Generally, the catheter
line can be safely and quickly removed by a trained nurse, in a matter of minutes.
 After removal, the insertion site is normally bandaged with sterile gauze and kept
dry for a few days, which the wound can close and begin healing.
 The tip of the catheter is sent to Microscopy culture and sensitivity.

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 PULMONARY ARTERY CATHETHERIZATION

 Pulmonary Artery Catheterization (PAC), or right heart catheterization, is the

insertion of a catheter into a pulmonary artery.
 Its purpose is diagnostic; it is used to detect heart failure or sepsis, monitor
therapy, and evaluate the effects of drugs.
 The pulmonary artery catheter allows direct, simultaneously measurement of
pressures in the right atrium, right ventricle, pulmonary artery, and the filling
pressure (“wedge” pressure) of the left atrium.
 PAC is frequently referred to as Swan-Ganz Catheter, in honor of its inventors
Jeremy Swan and William Ganz, from Cedars-Sinal Medical Center.
 The catheter is introduced through large vein often the internal jugular,
subclavian or femoral veins. From this entry site, it is threaded through the
right atrium of the heart, the right ventricle and the subsequently into the
pulmonary artery. Inflate the balloon with 1.5 ml, and close the red tap on the
balloon inflation port. The passage of the catheter may be monitored by dynamic
pressure readings from the catheter tip or with the aid of fluoroscopy.

INDICATIONS
Not indicated as routine pulmonary artery catheterization in high risk cardiac and non-
cardiac patients.
 Indicated in patients with cardiogenic shock during supportive therapy
 Indicated in patients with discordant right and left ventricular failure
 In patients with severe chronic heart failure requiring inotropic, vasopressor and
vasodilator therapy
 Indicated in patients with suspected “pseudo sepsis”
 In some patients with potentially reversible systolic heart failure
 Indicated for the hemodynamic differential diagnosis of pulmonary hypertension

CONTRAINDICATION

 Tricuspid or pulmonary valve prosthesis which can be damaged

 Tricuspid or pulmonary valve vegetations which ca be dislodged
 Endocarditis in general
 Right heart mass (be it tumor or clot.)
COMPLICATIONS
 Arrythmias
 Thrombosis and hemorrhage along the path of the PAC
 Intracardiac knotting of catheter
 Pulmonary hemorrhage
 Infection
 IJ/Subclavian stenosis
 Pulmonary infarction
 Pulmonary artery rupture
 Right sides endocarditis
 Air embolism

PRECAUTIONS
 Catheter may need to be re floated
 Ensure that the wedging syringe has not been left full of air and accidentally been
inflated
 Do not attempt to inflate or flush a wedged balloon.
 Check pressure scale and waveform
 If catheter is wedge ensure balloon is deflated and pull catheter back 1-2 cms
 Reassess trace

Balloon rupture:
 There should be slight resistance when inflating balloon.
 If there is no resistance and no wedge trace assume that the balloon has a
ruptured and alert registrar for removal and re-insertion