I.V. Essentials: Picking up on PICC lines
Jerome Argame BSN, RN-BC

Nursing Made Incredibly Easy!
February 2014 
Volume 12  Number 1
Pages 14 - 16
  PDF Version Available!

Peripherally inserted central catheters (PICCs) are often used for patients needing central venous (CV) access, both in the hospital and out. Clinicians greatly prefer them over femoral catheters and internal jugular catheters to provide CV access for appropriate patients. Why? PICC lines use blood vessels farther away from the large arteries found near the femoral and internal jugular region.Because you're likely to encounter more and more PICC lines no matter where you work, you need to understand them and their indications and contraindications (see Guide to PICC lines). You also need to know how to assess, maintain, and manage PICC lines to ensure they're functioning effectively. For all the details, read on.Manufactured with single, double, or triple lumens, PICC lines are indicated for a variety of uses. These include infusing multiple I.V. fluids, long-term antibiotics, chemotherapy, or total parental nutrition (TPN); drawing blood; and even monitoring central venous pressure (CVP). Some PICC lines have specialized catheter tubing that can tolerate the high pressure per square inch needed for a computed tomography scan with contrast, usually about 300 psi.Using ultrasound to search for deep veins in the upper arm, PICC lines are often placed at the bedside or in the OR by specially trained nurses. They may also be placed by interventional radiologists or physicians. PICC lines are usually placed in the basilica or brachial veins in the upper arms but can also be placed in the cephalic vein. The PICC line insertion specialist measures and documents the circumference of the patient's arm before the PICC line is inserted to establish a baseline circumference.Some patients with an implanted defibrillator or pacemaker may not be able to have a PICC line inserted in an extremity. The good news? Most of these patients can have the PICC line inserted on the opposite arm to avoid interfering with the pacemaker wires.For a PICC line to be effective, the patient needs to

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