Peripherally inserted central catheters (PICCs) offer several clinical advantages in the intensive care unit (ICU), particularly for patients with complex medical needs. These benefits include safety, versatility, and ease of placement, making them a valuable option for specific scenarios in critical care.
Key Advantages
- Safety in High-Risk Patients:
- PICCs are safer than central venous catheters (CVCs) for patients with coagulopathies or altered neck anatomy. Their insertion carries minimal risk of pleura-pulmonary damage, hemorrhage, or hematoma, which is particularly beneficial in critically ill patients prone to bleeding complications.
- PICC placement can prevent unnecessary blood transfusions to correct coagulation abnormalities required for CVC insertion.
- Low Risk of Infection:
- PICCs are associated with a lower risk of catheter-related bloodstream infections (CRBSIs) compared to CVCs, especially when properly maintained. This advantage is significant in ICU patients who are already at high risk of infections due to their critical condition.
- Ease of Placement:
- Bedside ultrasound-guided PICC placement is technically feasible and has a high success rate, even when performed by critical care fellows. This allows rapid access in situations where inserting a CVC may be challenging.
- PICCs can be placed without requiring an operating room or interventional radiology, making them more accessible in urgent situations.
- Versatility:
- PICCs can deliver high infusion rates through power-injectable lines, making them suitable for fluid resuscitation and other intensive therapies.
- They are useful for administering medications, fluids, parenteral nutrition, and blood products over extended periods.
- Facilitation of Care Transitions:
- PICCs are ideal for ICU patients requiring long-term intravenous access as they facilitate transitions from critical care to general wards or outpatient settings without the need for reinsertion.
- Customizability:
- PICCs come in single, dual, and triple lumen configurations, allowing customization based on patient needs. Multi-lumen PICCs are particularly advantageous in ICU settings where multiple simultaneous infusions may be required.
While PICCs offer numerous advantages, their use must be carefully evaluated due to potential complications such as venous thromboembolism (VTE), catheter occlusion, and infection risks if not properly managed. Additionally, they may not be suitable for unstable patients requiring immediate hemodynamic monitoring or very short-term intravenous access.
PICCs provide critical care teams with a safe and versatile option for intravenous access in ICU patients, particularly those at high risk of complications from traditional CVCs. Their ease of placement, low infection risk, and ability to support complex treatments make them an indispensable tool in specific ICU scenarios.
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References
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
Pittiruti, M. et al., (2012, February 4) Clinical experience with power-injectable PICCs in intensive care patients. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/22305301/
Castiello, L. (2023, February 14) What are PICC lines and why do doctors use them. Medical News Today. https://www.medicalnewstoday.com/articles/picc-line
Elli, S. (2022, September 09) How to insert a PICC: practical tips for the intensive care physician. About Science. https://journals.aboutscience.eu/index.php/aboutopen/article/view/2360/2586