PROCEDURE: Dual lumen PICC with ultrasound and fluoro
INDICATION:
DATE:
ACCESS SITE: vein with ultrasound
OPERATOR(S): , MD (Attending)/ , MD (Fellow)
MEDICATIONS: 2% Lidocaine without epinephrine for local
FLUOROSCOPY TIME: minutes
CATHETER: 5 French dual lumen power PICC
COMPLICATIONS: None immediate
TECHNIQUE:
The risks, benefits, and alternatives to the procedure were explained. Consent was obtained for PICC placement and contrast administration.
The upper extremity was ultrasonographically evaluated. An appropriate vein was identified, and the site was prepped and draped in sterile fashion. A timeout was performed. Using local anesthetic and under direct ultrasonographic visualization, the vein was punctured with a 21 gauge needle. An image was stored to PACS.
A 0.018″ wire was passed centrally and the needle exchanged for a dilator peel-away combination. The wire was used to determine catheter length, and a 5 French dual lumen PICC line cut to appropriate length. The tailored catheter was advanced through the peel-away and positioned centrally using fluoroscopy.
The peel-away was removed, and hemostasis achieved with manual compression. The catheter was aspirated, flushed, and heparinized per protocol. It was secured in place with 3-0 Ethilon. An antimicrobial disc and sterile dressing were applied.
The procedure was well tolerated, and the patient discharged from the angiography suite in good condition.
Findings:
- Vein patency and needle entry were documented by ultrasound and an image was stored to PACS.
- The catheter tip is near the cavoatrial junction.
Impression:
Uneventful image guided placement of 5 French dual lumen PICC in the upper extremity as described.
Frequently Asked Questions
What is a dual lumen PICC?
A dual lumen PICC (Peripherally Inserted Central Catheter) is a type of catheter with two separate channels, or lumens, within a single tube. This allows for different medications or fluids to be administered simultaneously without mixing. It's often used in patients who require long-term intravenous therapy, such as chemotherapy or nutrition.
The procedure involves using ultrasound to locate a suitable vein in the upper arm. A needle is used to puncture the vein, and a guide wire is inserted. A catheter is then threaded over the wire and positioned using fluoroscopy, a type of real-time X-ray. The placement is secured with sutures and dressed with a sterile covering.
What are the benefits of using ultrasound for PICC placement?
Ultrasound guidance increases the accuracy of vein selection and needle insertion, reducing the risk of complications such as accidental arterial puncture or nerve damage. It enhances patient comfort and the success rate of the procedure by providing real-time imaging of the vein.
What are the potential complications of PICC line placement?
While generally safe, potential complications include infection, bleeding, blood clots, and catheter malposition. However, using ultrasound and fluoroscopy helps minimize these risks. It's important for the medical team to monitor the insertion site and catheter function regularly.
Why is heparin used during PICC placement?
Heparin is used to maintain catheter patency and prevent blood clots from forming within the catheter. It is a blood thinner that ensures the PICC line remains open and functional for delivering medications or fluids.
What is the purpose of the antimicrobial disc in PICC placement?
The antimicrobial disc is placed at the catheter insertion site to prevent infection. It releases antiseptic agents that kill or inhibit the growth of microbes, providing an additional layer of protection against infections.
How is the length of the PICC line determined?
The length of the PICC line is determined using a guide wire. The wire is inserted into the vein, and its length is measured to ensure the catheter tip reaches the cavoatrial junction, where the superior vena cava meets the heart, ensuring optimal placement for medication delivery.
What is the significance of the cavoatrial junction in PICC line placement?
The cavoatrial junction is the ideal location for the tip of a central catheter like a PICC line. Placing the catheter tip here ensures efficient delivery of medications into the bloodstream and reduces the risk of complications like thrombosis or catheter malfunction.
What does 'fluoroscopy time' refer to in PICC placement?
Fluoroscopy time refers to the duration that fluoroscopy, a type of X-ray imaging, is used during the procedure to guide the placement of the PICC line. It provides real-time images, helping the medical team accurately position the catheter.