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I. INDICATIONS

Peripherally inserted central catheter (PICC) or percutaneous central venous catheterization (PCVC) involves inserting a long small-gauge catheter into a peripheral vein and threading it into a central venous location. The catheter can be placed in large vessels such as the temporal vein in the scalp, cephalic and basilic veins in the arm, or the saphenous vein in the leg.

  1. When intravenous access is anticipated for an extended period. The Centers for Disease Control and Prevention (CDC) recommends placing PICC access if therapy is needed for >6 days.

  2. High-risk patient populations (surgical).

  3. In low birthweight infants when it is anticipated that full enteral feedings will not be achieved within a short period. Cochrane review found in one small study that the use of percutaneous central venous catheters increases nutrient output. Three trials suggested that the use of percutaneous central venous catheters decreased the number of catheters needed to deliver nutrition.

  4. Fluid delivery, nutritional solutions, and medications when other venous access is not acceptable or able to be obtained (eg, hypertonic intravenous [IV] solutions).

II. EQUIPMENT

  1. Basic supplies. Cap, mask, sterile gloves, sterile gown, transparent dressing, sterile tape strips, a sterile tray, locally approved bactericidal skin prep, a sterile tourniquet, sterile transilluminator cover (optional), saline flush solution, sterile saline wipes, sterile gauge, and a T-connector.

  2. Percutaneous catheter device. Silicone catheters and polyurethane catheters (typically with guidewire) are available. Some infants may benefit from dual lumen catheters due to multiple infusions or medication incompatibility. Ensure careful consideration when using dual lumen catheters due to increased associated risks, including catheter thrombosis and infection. According to the National Association of Neonatal Nurses (NANN) guidelines, the most commonly used PICC catheters are 1.1 to 2F (28- to 23-gauge) catheter. Use the smallest catheter possible to accommodate the vein. Choose proper-sized catheters because a catheter too large for a vessel may cause the vessel to spasm.

    1. Specialty antibiotic-coated catheters. Cochrane review (2015) found that although data from one trial did indicate that antimicrobial-impregnated central venous catheters might prevent catheter-related bloodstream infection in newborns, the available evidence is insufficient to guide clinical practice.

    2. Specialty heparin-bonded catheters. Cochrane review (2014) found 2 studies on heparin-bonded catheters that revealed no decrease in catheter-related thrombosis; 1 study did report a decrease in catheter-related bloodstream infections and colonization with the use of heparin-bonded catheters.

III. PROCEDURE

If a guidewire is present, it needs to be removed before blood is withdrawn or the catheter is flushed. Providers placing lines need to be trained with competency check off, to maintain skills with a designated minimum number of insertions per year, and to be comfortable with manufacturer guidelines specific to catheter devices. A review of the NANN Guideline for Peripherally Inserted Central Catheters (see Selected References) is suggested.

  1. Obtain informed consent and perform a time-out. Gather the equipment and assemble the tray with the catheter using ...

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