Peripherally inserted central catheters are used to obtain central venous access in patients undergoing treatment in acute care facilities, home health agencies and skilled nursing care in a variety of settings. PICC lines are reliable alternatives to other central venous catheters and have lower risks of complications. But a PICC is not appropriate for all the patients. Therefore, proper patient selection taking into consideration indications and needs for use, risks versus benefits, contraindications and complications must be considered prior to insertion of a PICC.
Some of the various indications of a peripherally inserted central catheter are as follows:
Long Term Chemotherapy:
Chemotherapy is medication administered to treat some types of cancer. Chemotherapeutic drugs can be administered either orally or intravenously depending on the type of the medication. Some of the agents cause damage to the tissues and require infusion into large vessels to minimize, if not eliminate, such damage. The PICC line is ideal for this purpose and can be used for a few weeks, months and up to one year with proper care before it is discontinued. PICC lines can be used for short infusions or continuous infusions of the chemotherapeutic medications.
Hyperalimentation is a form of nutrition that does not utilize the digestive system. It nourishes the body completely through IV access and may be given to patients who are unable to process and absorb nutrients because of persistent vomiting, severe diarrhea or intestinal diseases. All the proteins, calories, vitamins and minerals can be given through the venous system but must be given through a central vein, such as the Superior Vena Cava (SVC), to prevent complications. Hyperalimentation is usually continued for long periods of time and because a PICC line can remain for such duration, it is ideal for this use.
Repeated Administration of Blood or Blood Products:
Patients with blood disorders, such as anemia, low platelet counts, or coagulation disorders, may require repeated blood or blood products. PICC lines can serve this purpose as they can stay for a longer time avoiding repeated catheter insertion. In addition, most have large gauge lumens necessary to accommodate blood administration.
Venous Blood Sampling:
Patients often require repeated blood sampling to obtain lab values. PICC lines are often used to provide such laboratory samples, often on a daily basis.
Reduced Number of Needle Punctures to Skin:
Very ill patients may not tolerate repeated needle pricks. Repeated puncture to the skin may also increase risk of infection, which can worsen the condition of an already sick patient. PICC lines help in avoiding repeated skin pricks for various reasons such as requiring multiple IV sites, replacement of existing sites, or blood sampling, and are therefore, quite beneficial. This is especially true in neonatal intensive care units where the preterm and low birth weight babies succumb to problems very rapidly and repeated skin pricks can increase the risk of infection.
Measurement of Central Venous Pressure:
Central venous pressure monitoring is often obtained in patients with cardiovascular disturbances, especially those undergoing treatment in ICU. Since the tip of the PICC line is advanced near the heart, it can be used to measure the central venous pressure. This helps in assessing the status of the patient and to determine whether he is improving or deteriorating.
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