Peripherally Inserted Central Catheters Brandon STAhlMAN | UC Davis Medical Center | April 2017

PICC's are designed to provide reliable venous access for short, intermediate, and long term therapy.

WHO CAN PLACE THEM?

At UCDMC, RN’s that have vascular access certification can place PICC’s. Can MD’s place PICC’s?*

This is done as a sterile procedure, in some cases, sometimes requiring sedation. This requires coordination with staff, usually other RN’s.

For most of the hospital, specially trained PICC RN’s insert PICC’s. Many NICU RN’s have vascular access certification and therefore, they insert their own PICC’s.

APPROPRIATE INDICATIONS

To determine what type of access is correct for a patient, many factors come into play. PICC could be indicated if:

  • Duration of therapy (more than a week?)
  • Type of infusate being used (TPN, vesicants, CHEMO ABX VASOPRESSORS, pH <5 or >9, >500 mOsm)
  • Contraindiated if CKD stage III or greater
  • For peripherally compatible infusate, MAGIC deemed a PICC appropriate for ≥ 6 days. Preferred to a midline catheter if proposed duration of infusion is ≥ 15 days.
  • For non-peripherally compatible infusates, PICC’s were deemed appropriate at all times.
  • For patients with difficult venous access, PICC’s were deemed appropriate for ≥6 days; preferred to tunneled catheters for 15-30 days. (disagreement on appropriateness of PICC for use <5 days).
  • For patients requiring frequent phlebotomy, appropriate for ≥6 days; preferred to tunneled catheter for 15-30 days. (disagreement on appropriateness of PICC for <5 days)

CONTRAINDICATIONS

  • Location
  • Is the patient burned on both arms?
  • Future access for dialysis / AV Fistula / Graft?

(For use in adult populations)

MAGIC

(Michigan Appropriateness Guide for Intravenous Catheters)

A multi-specialty panel has designed a best practices guide for the "insertion, care, and management" of peripherally inserted central catheters (PICCs). This toolkit was designed to give providers guidance of choosing an appropirate VAD for patients, taking their risk factors into consideration.

Thank you for your time.

Please contact me with any questions:

Brandon Stahlman, ICU RN, UC Davis Medical Center 503.522.0710 | bstahlman@ucdmc.com

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