Minimally Invasive Tumor Therapy (MITT)

Department of Radiology, Charité – Universitätsmedizin Berlin

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References

  1. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011 May;39(4 Suppl 1):S1-34. doi: 10.1016/j.ajic.2011.01.003.
  2. O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.
  3. Moureau N. Vascular safety: it's all about PICCs. Nurs Manage. 2006 May;37(5):22-7; quiz 50. Review.
  4. Gebauer B, Beck, Wagner HJ. Zentralvenöse Katheter: Diagnostik von Komplikationen und therapeutische Optionen. Radiologie up2date 2008; 8(2): 135-154 DOI: 10.1055/s-2007-995703

Peripherally Inserted Central Catheter (PICC)

 

What is a PICC?

 

PICC stands for peripherally inserted central (venous) catheter. A PICC is a thin, flexible plastic tube with a diameter of 3 - 6 French (1.0 – 2.0 mm) for insertion into a deep vein in the upper arm. From the venous entry site, the catheter is advanced toward the heart until the tip rests in the area were the superior vena cava enters the right heart (the cavoatrial junction). The length of the catheter is variable and is individually adjusted to fit each patient’s anatomy. PICCs can be used for blood sampling and for the delivery of medications. A special type of PICC allows high-pressure injection of contrast agents (up to 4 ml/s with an upper pressure limit of 325 psi) for imaging exams like computed tomography (CT) or magnetic resonance imaging (MRI). PICCs have the advantage of easy insertion and easy removal. They are recommended for mid-term therapy (1 - 6 months). Because these catheters are inserted into a smaller vein, good blood clotting is less important than for catheters which are inserted into a large, central vein. A PICC can be used for intravenous therapy at home.

 

How is a PICC Placed?

 

A PICC is placed under local anesthesia using ultrasound and X-ray guidance. The interventional radiologist first punctures a superficial (basilic vein) or deep (brachial vein) vein in the upper arm with a cannula. Next, a guidewire is inserted through the cannula, which is then withdrawn. The flexible catheter can then be advanced over the guidewire (this is known as the Seldinger technique). The catheter is secured in place by a special device (e.g., Statlock©) at the exit site in the upper arm, just above the bend of the elbow, and sterile dressing is applied.

 

Figure 1: A PICC is inserted through a vein in the upper arm and advanced toward the heart. During the procedure, the tip of the PICC will be positioned in the large vein entering the heart (superior vena cava). With the tip just above the heart, the PICC can be used for all kinds of intravenous therapies.

 

What are the Risks of PICC Implantation?

 

Unlike other central venous catheters, which require puncturing a large, central vein, a PICC is inserted through a smaller vein in the upper arm under ultrasound guidance. Accessing a smaller arm vein has much fewer complications, making the placement of a PICC line a very safe procedure. Therefore, a PICC is also an option for critically ill patients or patients with poor blood clotting. When the PICC is placed by an interventional radiologist, the combined use of ultrasound to guide vein puncture and X-ray imaging to guide catheter positioning reduces the risks even further.

 

Possible risks are bleeding and hematoma formation (bruising) and accidental puncture of an artery or nerve in the upper arm. After the procedure, while the catheter is in place, there is a risk of infection or abscess formation. Also, there may be thrombosis of the vein or catheter.

 

How is a PICC Cared for?

 

A PICC needs to be flushed with a 0.9% saline solution regularly. The stabilization device should be replaced once a week. With proper care, and unless there are complications, a PICC can stay in place longer than 3 months. A PICC is usually inconspicuous when the patient wears long-sleeved garments.