PICCs are thin, flexible plastic tubes with a diameter of 1 to 2 mm. The PICC is not sited centrally (like the CVC), but rather peripherally into the venous system (PICC = peripherally inserted central venous catheter). PICCs are inserted in the deep upper arm veins. The tip of the catheter is positioned in the cross-over of the superior vena cava in the right atrium of the heart. The length is custom-adapted to the patient.

PICCs have the advantage that they are relatively easy to implant and remove. They are primarily used for medium-term central venous therapy (1 to 3 months). Since the catheters are inserted peripherally, blood clotting does not play such a major role in the doctor’s decision. PICCs can be used for home-based treatment.

PICCs are suitable for taking blood as well as for administering medication. Special PICCs are also available for high-pressure injections (up to 4 ml/s and up to a pressure of 325 psi) of contrast medium used in CT or MRI scans.

PICCs are sited under local anaesthetic and using ultrasound and X-ray guidance. The superficial (vena basilica) or deep (vena brachialis) vein of the upper arm is punctured using a cannula and the catheter is then fed into the vein using a guide wire (this is known as the Seldinger technique). At the exit point on the upper arm just above the elbow, the catheter is secured in place with a special adhesive dressing (e.g. Statlock©) and covered with a sterile dressing.

Figure 1: The PICC is inserted via a vein in the upper arm. The tip lies in the superior vena cava close to the heart so that all intravenous treatment can be delivered via a PICC.

PICCs should be regularly flushed with 0.9% saline solution. The PICC’s adhesive dressing should be changed on a weekly basis. With the correct care and providing no complications occur, a PICC can also be left in situ for more than 3 months. With long-sleeved clothing, the PICC is normally invisible from the outside.

Unlike other central venous catheters, a vein in the upper arm is punctured using ultrasound guidance for a PICC, rather than a central vein. Consequently, the complications associated with this procedure are far less, making the implantation very safe. This means that a PICC can be sited in critically ill patients or patients with poor clotting. The combination of ultrasound-guided venepuncture and fluoroscopy-guided (with X-rays) placement of the PICC means that the potential risks can be reduced even further.

Possible risks include bleeding and bruising, missed puncture of the brachial artery and puncture of a nerve. Over time there is also a risk of infection or the formation of an abscess, as well as thrombosis of the vein or catheter.

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Minimally Invasive Tumour Therapy (MITT)
Charité Campus Virchow-Klinikum (CVK)
Department of Radiology
Augustenburger Platz 1
13353 Berlin

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