As radiologists become more involved in the placement of PICCs, they should be aware of the indications and proper technique for placement, familiar with the characteristics of the available PICCs, cognizant of the potential complications, and able to manage patients once the catheters are placed. With these skills, the interventional radiologist will be able to provide safe, comfortable, and reliable venous access for a large population of patients.
Peripherally inserted central catheters (PICCs) have become an
important means of central venous access. PICCs originally were
designed to be placed at the bedside, into visible antecubital
veins.1 Today, they often are placed by a radiologist in patients
without any visible arm vein.2,3 As radiologists become more
involved in the placement of PICCs, they should be aware of the
indications and proper technique for PICC placement, knowledgeable
of the pitfalls to be avoided, familiar with the various
characteristics of the multiple PICCs that are available, cognizant
of the complications associated with PICCs, and able to manage
patients once they have had a PICC placed. With these skills,
radiologists will be able to provide safe, comfortable, and
reliable venous access for a very large population of patients.
The veins of the upper extremity are grouped into superficial
and deep components (figure 1). The two main superficial veins of
the upper arm are the cephalic and basilic veins. The cephalic vein
is a superficial vein which extends from the radial side of the
wrist along the lateral aspect of the upper arm, traversing the
pectral-deltoid groove to insert into the axillary vein. The
basilic vein arises along the ulnar side of the forearm and extends
to the shoulder, where it is joined by the deep brachial veins to
form the axillary vein. The large superficial antecubital vein
connects the cephalic and basilic veins at the elbow.
The brachial vein is the main deep vein in the upper arm and it
is often paired. These veins course in a common fascial sheath with
the brachial artery. The brachial vein is formed from the
confluence of the radial, ulnar, and interosseous veins of the
forearm. Normal brachial veins usually are small, as most of the
blood flow is via the superficial veins.
The indications for placement of a PICC are broad (table 1).
PICCs greatly improve patient comfort by avoiding the need for
frequent vein punctures to maintain peripheral IV access or to draw
Referring physicians appreciate the reduced risk of placing a
PICC compared to placing a temporary subclavian or internal jugular
line. PICCs are safe, reliable, and easy to care for, making them
ideal for home IV therapy.
Though almost every patient is able to have a PICC, alternative
access becomes necessary when a patient has no continuous arm vein,
or has extensive burns or a diffuse dermatological disorder
involving the upper extremities (table 2). Acute upper extremity
deep venous thrombosis also is an important contraindication to
PICC placement. Placement of a PICC in a paralyzed extremity or in
the arm ipsilateral to a mastectomy is associated with an increased
risk for developing severe thrombophlebitis. Chronic central venous
occlusion is only a relative contraindication to placement of a
PICC. Although superior vena cava (SVC) or subclavian vein
occlusion may be present, a PICC can still be placed with its tip
positioned just peripheral to the level of the occlusion.
Many patients referred for vascular access suffer from severe
thrombocytopenia or anemia. In these patients, PICC placement may
be the only reasonable option for venous access. Because most PICCs
are placed into superficial veins in the arm, these catheters can
be placed safely despite a moderate anemia or coagulopathy.
However, a prothrombin time within 3 seconds of control, a
hematocrit of 30%, and a platelet count of 100 K/uL is
Whenever possible, avoid using an upper extremity vein as an
access site in patients with end-stage renal disease. Damaging an
upper extremity vein may reduce the number of sites available for
creation of hemodialysis fistulas.
All central lines can be a source of cellulitis, sepsis, or air
embolization. These serious complications are less likely to occur
if patients have a good support system at home. Therefore, it is
important to determine who will be caring for the PICC prior to its
A good history and a directed physical examination are essential
prior to PICC placement. A recent complete blood count, serum
chemistries, prothrombin time, partial thromboplastin time, and
electrocardiogram are helpful prior to placement of any central
line, including PICCs.
The most important part of the pre-procedure evaluation is
determining the indication for line placement and the planned
duration of use. Choosing the correct type of line also is a very
important component of the preparation process.
Types of PlCCs
There are a wide variety of PICCs available. No single design
has been found to be clearly superior; rather, the catheter
selection must be tailored to each individual patient.4
The catheter tips have two basic designs: end-hole and valved
(Groshong-type) (figure 2). The most common style of catheter tip
is the end-hole design. Its primary advantage is that it can be
advanced coaxially over a guidewire. A staggered-tip, dual lumen
end-hole catheter has one lumen exiting the catheter proximal to
the catheter tip. This design allows for simultaneous infusion of
incompatible substances. However, these catheters cannot be trimmed
without sacrificing the staggered-tip.
The Groshong valve-tip (Bard, Salt Lake City, UT) has no
end-hole but rather a slit near its tip that functions as a valve
to prevent spontaneous back-flow of blood into the catheter. This
design only requires saline to flush the catheter, thereby
simplifying line care.5 Groshong-tip catheters also are valuable
for patients with a known heparin allergy or heparin-induced
One of the most important considerations in selecting a PICC is
the minimum number of lumens required. Single lumen catheters are
easier to maintain and provide a larger lumen, which allows for
more rapid infusions or infusion of more viscous solutions (i.e.,
blood products). Whenever possible, a single lumen catheter should
be placed. However, most of the PICCs placed are dual lumen because
of the requirement for multiple, simultaneous infusions.
The larger the catheter, the better the flow rates; however,
larger catheters are more difficult to place and more likely to
occlude small arm veins. Sizes for pediatric patients typically
vary from 2 to 4 French (F), while most adults receive either a 4
to 5-F single lumen or a 5 to 6-F dual lumen PICC.
Almost all the PICCs available today are made from either
silicone or polyurethane (PU). Each of these materials has distinct
advantages. PU provides a stronger, thinner-walled catheter. Thus,
a 5-F PICC made of PU has a bigger inner diameter (ID) than a 5-F
PICC made from silicone (figure 3). The potential disadvantage to
PU is that it is stiffer, and there is a theoretical concern that
PU catheters are more likely to cause vascular injury. There are
also some formulations of PU that have been known to become brittle
on long-term exposure to blood. Despite these concerns, many
patients have had PU PICCs in place for over a year without any
Silicone is biocompatible, non-thrombogenic, and is associated
with a low infection rate.6 Silicone is not as strong as PU, which
necessitates silicone catheters having thicker walls to provide
adequate rigidity and resistance to rupture. Their thicker walls
mean smaller IDs and lower flow rates than for PU catheters of the
same outer diameter.
One of the greatest drawbacks to PICCs is their limited flow
rate, due to their small inner diameters. Whether the catheter is
single or dual lumen, silicone or PU, or 4, 5, 6, or 7-F will
greatly affect the ID of the catheter lumens. PICC flow rates also
are limited by their long length (typically 50 to 60 cm). These
factors together make PICCs unreliable for infusing blood
products.4 The viscosity of packed red blood cells (PRBCs) varies
greatly from one unit to the next. Therefore, one unit of PRBCs may
infuse well, but another may not infuse at all. Because a unit of
PRBCs must be completely infused within four hours or the remaining
blood must be discarded, placement of a PICC in a patient that
needs frequent transfusions is not recommended. If these patients
must be infused through a PICC, a single lumen PU catheter is
The pressure required to generate the 1 to 3 cc/sec of contrast
injection for chest and abdomen computed tomography (CT) is too
great for most PICCs. Single lumen PU catheters are the most
reliable to use for power injection.4,7 The flow rates, at a given
pressure, are better for a shorter catheter than a longer one.
Therefore, trimming the PICC to remove excess catheter length prior
to its placement will improve flow rates.
Overall, the single lumen catheters are easier to manage,
provide better flow rates, and appear to plug less frequently. For
these reasons, placement of a single lumen catheter should be
encouraged whenever possible.
For PICC placement, the patient is situated with the arm
positioned at about 45 degrees of abduction. Careful sterile
preparation and draping of the arm is the key to achieving a low
infection rate.8 A 10 minute betadine scrub is performed, followed
by application of a betadine solution. Once this is dry, alcohol
should be used to remove all the residual betadine. Sterile drapes
are placed to provide a sterile field centered on the upper
Placement of a PICC into the forearm or antecubital fossa
requires a catheter that is unnecessarily long and is exposed to
kinking caused by flexion at the elbow and, therefore, placement in
the upper arm is preferred. Patients also find it more comfortable
to have their catheter placed in the upper arm.
There are 4 different methods for visualizing the arm veins
during PICC placement: (1) direct visualization or palpation; (2)
IV contrast; (3) IV carbon dioxide (CO2); and (4) ultrasound. A
number of manufacturers package PICCs in a kit that provides the
components needed to place the line using the Seldinger technique
A small percentage of patients have a visible or palpable
basilic or cephalic vein in the upper arm. In these cases, a
tourniquet, placed high on the upper arm, allows direct puncture of
the vein using a 22 G angiocatheter (Johnson & Johnson Medical,
Arlington, TX). Once the angiocatheter is in the vein, an 0.018"
guidewire is advanced, as described below.
Unfortunately, the large majority of patients referred for a
PICC have no visible or palpable superficial vein. However, an
upper arm vein can easily be opacified by injecting one-third
strength iodinated contrast into a more peripheral IV line. This
method requires some type of peripheral IV access; a small gauge IV
in the forearm or hand usually can be introduced in most patients.
The excellent opacification provided by IV contrast allows most of
PICCs to be placed using less than 10 cc of contrast material. A
tourniquet should not be used when using IV contrast, as there is
marked leakage of contrast at the puncture site when the vein is
distended. In patients with a contrast allergy or renal
insufficiency, intravenous CO2 also can be administered in order to
visualize the veins (figure 4). The patient is given a slow
injection of approximately 10 to 20 cc of CO2 via a peripheral IV.
It is best to use a tourniquet to slow the passage of the gas. The
image contrast may be poor and, thus, several punctures may be
needed to gain access into the vein.
The majority of PICCs can be placed using ultrasound guidance.
Use of a 5 to 7.5 MHz linear array transducer and a tourniquet
facilitates visualization of arm veins. Many of our patients have
had multiple peripheral IVs and their superficial veins are
sclerosed, making access via the brachial vein necessary. However,
when the brachial vein is punctured using IV contrast guidance, the
needle may inadvertently traverse the brachial artery.
An important advantage of ultrasound guidance is that it allows
clear location of the arteries. When using ultrasound, a puncture
site that keeps the vein superficial to, or beside, the artery can
be chosen. The needle is then advanced into a suitable vein using
real-time imaging (figure 5). If needed, the arm can be rotated
internally or externally to facilitate the vein puncture.
Following localization of the vein and prior to the puncture, 1%
lidocaine, without epinephrine, is used to raise a dermal wheal at
the intended site of puncture. The 25 G needle should not be
advanced so deep as to enter the vein of interest and cause spasm
of the vein or a perivenous hematoma. When using fluoroscopic or
ultrasound guidance, a 7 cm, 21 G needle is used to puncture the
vein. This needle is large enough to accept an 0.018"
The veins are compliant, thus a double wall puncture is
frequently performed when using fluoroscopic guidance. It also is
helpful to have the orientation of the needle parallel to the
course of the vein (figure 6). The technique for ultrasound guided
puncture is similar, but often a single wall puncture of a
distended vein is sufficient because a tourniquet is in place. Once
the ultrasound-guided puncture into the vein is made, fluoroscopy
is used to visualize passage of the guidewire.
Whatever method is used to access the vein, the remaining
portion of the procedure is always performed in a standard fashion.
The 0.018" guidewire is gently advanced through the needle. If it
does not pass easily into the vein, the needle is slowly withdrawn
during fluoroscopic visualization. The vein is then gently probed
with the guidewire, which should advance easily once the needle tip
is in the vein. After guidewire access into the vein is gained, a
small incision with a number 11 blade and blunt dissection of the
puncture site greatly facilitates the advancement of the peel-away
sheath and the PICC. A peel-away sheath should then be advanced
over the guidewire. Once the sheath is in the vein, the guidewire
and dilator are removed. Some manufactures provide a long 0.018"
guidewire that can be used to size the length of PICC that will be
needed. The catheter is then advanced through the peel-away sheath,
without a guidewire, into the SVC. The tip of the PICC is
positioned in the SVC at the caval-atrial junction (figure 7). As
with most conventional central lines, retraction of the catheter
tip can be expected after placement.9 The position of the catheter
is documented using a tightly collimated chest radiograph. All
PICCs have adequate radiopacity to identify the tip of the
Next, the catheter is affixed to the skin, sutured in place with
2 to 4 stitches of a non-resorbable material (3-0 Prolene, Ethicon
Inc., Somerville, NJ), as tape is not reliable for fixation.
Although the ideal dressing is debatable, we prefer to place a
clear plastic adhesive dressing over the PICC site. Both ports are
flushed with heparinized saline (2 cc of 100 units/cc heparin),
clamped, and then capped. Instructions for catheter care are
reviewed with, and a copy given to, the patient. A copy of the
instructions are also placed in the chart. These instructions
include a phone number to call should any questions arise.
The most common pitfall encountered is the inability to puncture
the vein of interest or an inability to advance a guidewire into
the vein. If the first pass of the 21 G needle is unsuccessful,
intense spasm of the vein often will occur. Administration of 100
ug of nitroglycerin through the peripheral IV, with simultaneous
compression of the other outflow veins may be helpful for relieving
the venospasm. If the spasm persists, or a hematoma develops, then
a more central puncture in the same vein, or puncture of a
different vein is often necessary.
Central venous stenoses or occlusions are other common pitfalls.
The small size of PICCs allows them to be advanced into the SVC in
almost all patients-even those with central venous stenoses.
However, if the catheter cannot be advanced into the SVC, an upper
extremity venogram should be performed. If the subclavian vein is
occluded in one arm, the PICC should be placed in the contralateral
arm. In patients with bilateral central venous occlusions, the PICC
tip can be positioned peripheral to the occlusion and still be a
valuable venous access site.
While advancing the PICC, the veins usually are not opacified.
Rarely, the catheter will exit the main venous channel and pass
into a small parallel collateral channel. When this occurs, it may
be necessary to pull the catheter back and perform a contrast
injection. Advancing a small torqueable guidewire through the PICC
may be necessary on occasion to facilitate placement of the line in
the main venous channel, or to successfully advance it into the
A PICC should not be placed in a persistent left SVC (figure 8)
because the left SVC drains into the coronary sinus, and
pericatheter thrombosis can lead to coronary sinus thrombosis. The
left SVC may be mistaken for the descending aorta and the operator
may pull out the PICC assuming it has inadvertently been placed
into the brachial artery. A contrast injection should be made to
confirm the PICC position prior to removing it.
Overall, the complication rates associated with PICCs are
similar to or less than those associated with other central lines.
PICC complications can be generally divided into early (less than
three days) and late (greater than three days) types.
Early complications include bleeding, hematomas, nerve or
arterial injury, acute thrombophlebitis, and arrhythmias. Puncture
site problems are the most common early complications. Using a
peel-away sheath for PICC placement can lead to pericatheter
bleeding immediately after catheter placement and sheath removal.
This oozing of blood around the catheter at the insertion site can
persist for minutes or hours. Light pressure for 10 minutes usually
will control the bleeding. Otherwise, a gelfoam sponge can be
placed on the puncture site.
If bleeding is persistent and coagulopathy is not present, an
arterial injury should be suspected. Arterial injury is often due
to inadvertent through-and-through puncture of the brachial artery
when performing brachial vein puncture using fluoroscopic guidance.
It also may occur when the brachial artery is mistaken for the
brachial vein while attempting an ultrasound-guided puncture.
However, ultrasound guidance usually allows continuous
visualization of the artery during puncture of the brachial vein. A
color duplex examination also can be performed prior to the
puncture to insure that the vein is correctly identified.
If there is any question about the possibility of a
transarterial venous puncture, a pull-back test can be performed.
After the peel-away sheath is introduced over the guidewire, the
dilator is removed. The sheath is then slowly withdrawn over the
.018" guidewire. If the needle traversed the artery, a sudden flash
of arterial blood from the peel-away sheath will be seen. If no
flash of arterial blood is seen, the dilator and peel-away sheath
can then be re-advanced over the 0.018" guidewire, and the PICC is
Nerve injury is rare and is most likely to occur during brachial
vein punctures. Symptoms of nerve injury include immediate pain or
numbness radiating to the hand. If these symptoms occur, the
puncture needle or the catheter (if the PICC has already been
placed) should be removed immediately. A new line should then be
placed in the other arm. The symptoms usually will resolve within
Arrhythmias are associated with advancing the PICC into the
right heart. These will usually resolve when the catheter is
withdrawn into the SVC.10
Acute superficial thrombophlebitis is another complication. It
usually is associated with pain and tenderness, and perhaps mild
erythema, along the course of the accessed vein. This problem
usually resolves within 24 to 48 hours following conservative
therapy with arm elevation and moist local heat. If symptoms
persist despite adequate conservative therapy, a superimposed
infection should be excluded, and it may be necessary to remove the
Late complications include line plugging, catheter dislodgement,
line fracture, venous thrombosis, exit site infection, and sepsis.
Line plugging is the most frequent late complication and is best
prevented by meticulous maintenance flushes using heparinized
saline. The second most common late complication is catheter
dislodgement, which can occur despite suturing the catheter to the
skin. Dislodgement is common in uncooperative patients, and for
them, a port may be preferable. Fortunately, almost all the line
fractures occur in the portion of the catheter external to the
puncture site, and are seen more frequently with silicone
Thrombophlebitis occurs in approximately 1 to 10% of patients
with PICCs.11,12 There are 2 distinct presentations. Most cases of
phlebitis appear in the first few days after placement, as
previously discussed. These cases are probably due to the
manipulation of the veins with catheters and guidewires, or to the
presence of a PICC in a relatively small arm vein.
Late presentations (greater than 3 days) are related to either a
line infection or significant venous thrombosis. Infected lines
usually are removed immediately, and the catheter tip is
then cultured. Patients with severe thrombophlebitis symptoms
should be systemically heparinized. Fortunately, instances of
central venous thrombosis are rare (approximately 1%) with PICCs.
This is an important difference from conventional chest-wall venous
access catheters, where symptomatic central thrombus forms in up to
8% of patients.13 The rate of sepsis associated with PICCs is
similar to that of tunneled central lines (1 to 3%).11-14
Approximately 2% of patients with PICCs develop local
Findings will include insertion site erythema, tenderness,
induration, purulent drainage, and fevers. These lines should be
removed and cultured. If venous access is still needed, a new PICC
should be placed in the opposite arm and antibiotics initiated
pending results of the catheter tip culture. The main differential
diagnosis for exit-site erythema is an allergic reaction to the
tape used on the dressing or the catheter itself.
Starting a PICC service means a large investment of personnel
and time into care of these lines. The following instructions are
given to a patient or their care providers in order to minimize the
occurrence of problems: (1) The lumens should be flushed after the
completion of any infusion; (2) for end-hole catheters, each lumen
must be flushed at least once every 12 hours (the flush consists of
10 cc of saline followed by 2 cc of 100 unit/ml heparin); (3) the
dressing must be changed every 3 days; and (4) the catheter is to
be kept sutured to the skin with non-resorbable sutures.
Another potential care issue is preventing contamination of the
lumen of the line and preventing entry of air into the line. Most
of the manufactures of PICCs include a clamp on the catheter near
the hub, which is used in addition to an injection cap on the
When a patient presents with a plugged PICC, the external
portion of the catheter is inspected for kinks or occlusive
sutures. Clearing the plugged PICC using a 10 cc syringe filled
with saline should be attempted. The small size of PICCs makes them
prone to plugging, and the thin wall of these lines also makes them
easy to rupture. About
9 ATM of pressure can be generated with a 10-cc syringe, whereas
a 3-cc syringe can generate about 21 ATM.15 Generally, the
catheters made from PU are stronger than the silicone catheters.
Silicone catheters have been shown to rupture or leak with
pressures of 3 to 11 ATM, whereas the pressure required to induce
rupture or leakage in PU catheters is at least 19 ATM. Therefore,
with plugged PU catheters, a 3 or 5-cc syringe can be used when
attempting to clear these lines. If simple flushing fails, an
attempt will be made to clear the line with 5000 units of urokinase
(UK) (Abbott Laboratories, Chicago, IL). If the line is completely
plugged, it can be difficult to get the UK into the catheter. In
this situation, a three-way stopcock and a 60-cc syringe on the
side-arm of the stopcock should help get the UK into the catheter.
The three-way stopcock is connected to the PICC. The syringe
containing the UK (5000 units in 2 cc of saline) and an empty 60-cc
syringe are attached to the 2 side-arms of the three-way stopcock.
By generating a negative pressure in the PICC with the 60-cc
syringe and then turning the stopcock handle open to the UK
syringe, some of the UK will be drawn into the plugged PICC. It may
be necessary to repeat this maneuver several times to facilitate
transfer of the full 5000 units (2 cc) of UK into the plugged PICC
lumen. The UK should be left in place for 10 minutes, and the
catheter is then flushed with saline. This process should be
repeated if needed. PICCs with a leak or only one plugged lumen can
often be safely rewired over a 0.018" Teflon-coated guidewire.
One of the main advantages of having PICCs placed in the
interventional suite is the greater than 99% technical success
rate. This compares with bedside insertion success rates of
approximately 74%.11 The average duration of catheter usage is
extremely variable, ranging from a day to greater than a year. In a
study by Cardella et al, the catheters remained in for an average
of 72.7 days.11 In 73.4%, catheters were removed because they were
no longer needed. In 22.6% of the patients, the lines were replaced
at least once to allow completion of the planned therapy. These
line exchanges occurred when the PICC became partially dislodged,
fractured, or partially plugged. In the remaining 4%, a new line
had to be placed at a different site to complete the therapy, due
to site infection, phlebitis, or suspicion of systemic
Although the number PICCs placed is increasing, there are
several important alternative venous access devices to consider
(table 4). As interventional radiologists, we must provide a good
venous access service, of which PICCs are just one component.
Consultation should be provided to the referring physicians
regarding the most appropriate type of access device for their
-Peripheral IVs, although certainly cheaper in the short term,
require frequent replacement, are inappropriate for infusions of
vein-sclerosing infusates, and do not allow for blood draws.
Conventional central lines
-Conventional central lines introduced through the subclavian or
jugular vein have a higher infection rate than PICCs. Traditional
temporary central lines also carry the additional risks of
pneumothorax or arterial injury.
Permanent central lines
-Tunneled central lines with a dacron cuff that becomes
incorporated into the subcutaneous tissues are considered a
permanent type of venous access. These lines are more costly to
place than PICCs, but they are still the most practical choice if
long-term therapy is needed. Patients who have had multiple central
lines or who have bulky mediastinal disease may have central venous
stenoses or occlusions. Tunneled catheters are large diameter
catheters and are more prone to inducing venous thrombosis if the
central veins are narrowed significantly. The small diameter of
PICCs allows placement in many patients with central venous
stenoses in whom a tunneled central line may be hazardous.
Other cuffed silicone catheters
-A Hohn catheter16 is a non-tunneled silicone catheter with an
antimicrobial cuff (Bard Access, Salt Lake City, UT or Cook, Inc.,
Bloomington, IN). Use of these catheters is an important
alternative to conventional central lines, tunneled central lines,
and PICCs. These
5-F single or 7-F dual lumen catheters are placed via the
subclavian or jugular vein and are designed for intermediate-term
access. They are introduced through a peel-away sheath, and have a
cuff attached to the catheter near the hub which is advanced into
the subcutaneous tissue at the puncture site. Infection rates are
similar to those of tunneled lines but the placement procedure is
easier.16 Unfortunately, patient satisfaction is not high when this
line is placed in the neck.
-Arm-port catheters are similar in size and length to PICCs but are
particularly intended for long-term (greater than 6 month) usage.
Placement is similar to PICCs, except that a pocket is made for the
port at the puncture site in the upper arm.17 The initial cost for
placement of an arm port is significantly more than that of a
PICCs have all the capabilities of a multi-lumen, tunneled
central line (blood sampling, simultaneous infusions of
incompatible agents, and delivery of infusates directly into the
central venous system) except for infusion of blood products.
Placement of PICCs is an outpatient procedure and can be performed
in about 20 minutes. There is no need for a prolonged recovery
time. Placement of PICCs by interventional radiologists provides
the safety of fluoroscopic guidance and a technical success rate
that is approximately 100%. Immediate complications are rare when
PICC placement is performed in the interventional suite.
The success rate for bedside insertion of PICCs is approximately
74%. The lower cost of bedside insertion by nurses has created a
two-tier system at some institutions: patients who fail bedside
insertion are then sent on to the interventional radiologist.
Unfortunately, what is lost in this two-tier system is the concept
of a venous access consultation service. A PICC is not for everyone
(i.e., the dialysis patient). In addition, the added cost of having
a PICC placed in the interventional suite is more than offset by
the savings associated with the potential delays in starting
intravenous therapy and higher complication rates associated with
bedside insertion. Just as important is the continuity of care that
occurs after line placement when all PICCs are placed by one
The placement of PICCs in the radiology suite has been found to
be more reliable and more comfortable. This is because the
antecubital fossa is a common insertion site for lines placed at
the bedside. These lines can be uncomfortable and are prone to
fracture, dislodgement, and kinking, when compared to PICCs placed
in upper arm veins.
Calculating the actual expense of placing and maintaining a PICC
is difficult, and the true cost-effectiveness of providing a PICC
service remains uncertain.
There are many indications for PICC placement, and the
radiologist can provide successful placement in nearly all patients
referred for the procedure. PICCs are associated with a very low
morbidity rate. Procedure planning must include a careful selection
of the appropriate type of venous access device for the clinical
situation. Perhaps most important to creating a viable PICC service
in the department of radiology is the development of an effective
post-placement care system. With appropriate organization and
attention to detail, creating a PICC service can be a rewarding and
productive activity. AR
1. Hoshal VL: Total intravenous nutrition with peripherally
inserted silicone elastomer central