![]() ![]() The tip of the catheter is in the same place for both. The only difference between a PICC and a TCVC is where the device exits from the body (Figure Four). What is the difference between a PICC and a tunnelled central venous catheter TCVC? The procedure can be performed by a range of clinicians including nurses, radiologists, ODPs, radiographers, surgeons, anaesthetists, anaesthetic associates etc. This approach ensures that physical and chemical damage to the internal walls of the vein is minimised (Spencer and Mahoney, 2017). Catheter to vein ratio (CVR) should be optimised to allow maximised blood flow around the catheter. It must be ensured that the tip of the catheter floats freely within the bloodstream in a large vein and parallel to the vein walls. The tip position of a PICC is important if thrombotic complications are to be avoided. Using a Modified Seldinger Technique (MST) the catheter is advanced along the target vein, past the axillary and subclavian vein until the tip reaches lower superior vena cava (SVC) or upper right atrium (Gorski et al., 2021) (Figure Three). Next, using ultrasound guidance, local anaesthesia (usually 1% lignocaine) is administered subcutaneously to anaesthetise the area around the target vein. Therefore, the patient is draped from head to foot and the operator dons’ hat, mask, gown and sterile gloves. Full barrier precautions are required for all central venous access device (CVAD) insertions (Loveday, 2014). Once an adequate vein has been identified, a surgical aseptic non-touch technique is ensured. Due to its small size, tortuosity and difficult path to the axillary vein, the cephalic vein is not recommended for use for PICC insertion unless there is no other option. The veins typically used are the basilic or brachial. Additionally, some PICCs are impregnated with solutions that can help reduce the risk of infectious or thrombotic complications.įirstly, a vein of an adequate size in the middle of the upper arm is located using ultrasound guidance (Dawson, 2015, Spencer and Mahoney, 2017). PICCs can be power injectable and suitable for the delivery of contrast media via an injection pump. This means that there is no mixing of medications when delivered through the lumens. This is because the lumens have separate fluid pathways. Each lumen of multi lumen PICCs should be treated as a catheter in its own right. PICCs are available as a single, dual or triple lumen device. As the name suggests, PICCs are central venous access devices, meaning that the tip of the catheter terminates in one of the large central veins of the body (Figure One). What is a peripherally inserted central catheter?Ī peripherally inserted central catheter usually referred to as a PICC, is a long tube made from silicone or polyurethane. This first article will focus on the description of the PICC and how it differs from the other long term vascular access devices. This series of articles aims to increase the skills and knowledge of clinicians who are responsible for the care and maintenance of PICCs. Additionally, clinicians should be skilled in the strategies and methods necessary to reduce device complications (Gorski, 2021, Kelly, 2019). To reduce the risk of complications, morbidity, and mortality, practitioners who manage VADs need to be educated and constantly updated about correct use and care of them. These advances include the use of needle-free devices, securement devices, and antiseptic caps, as well as chlorhexidine-impregnated discs and dressings (Apata et al., 2017 Kelly, Jones and Kirkham, 2017 Wang, et al. In addition to advances in insertion techniques, which include the use of ultrasound guidance (Hill, 2019) and the use of electrocardiography to determine catheter tip position (Pittiruti, 2015), advances in techniques and technology for the post-insertion management of VADs have also erupted. Over the past few decades, there have been many scientific advances in technology and techniques in the field of vascular access. Broadhurst, Moureau and Ullman (2016) agree and claim that the prevention of complications is possible with appropriate evidence-based practices. (2016), many such complications and failures are preventable. Most post-insertion complications are attributed to poor care and maintenance practices. ![]() They can occur in all devices including a PICC and are a significant burden on healthcare workers. It is now accepted that the presence of any VAD immediately places patients at risk of complications. Although Vascular Access Devices (VAD) have many advantages, the burden of harm associated with them is significant. ![]()
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