How to choose which PICC for your patient
In this article, we explore the latest findings and recommendations from the Infusion Nurses Society regarding the selection of the most appropriate PICC (peripherally inserted central catheter) size (lumen and gauge) for patients. The INS advises, “The catheter chosen should be of the smallest gauge and length, with the fewest number of lumens, and should be the least invasive device necessary to accommodate and manage the prescribed therapy.”
When planning patient care, vessel health and preservation are prioritized. When PICC Lines are determined to be the best option for a patient, INS recommends selecting catheter gauge to meet a catheter-to-vessel ratio of less than 45%.
Studies indicate that employing PICC lines with smaller gauges can lead to fewer risks and complications, particularly in terms of lower occlusion rates compared to double or triple-lumen alternatives. While larger lumen PICC lines may be favored for specific medical evaluations like cardiac index assessment, selecting smaller lumen sizes is frequently linked with a reduced occurrence of mechanical complications and instances of deep vein thrombosis, particularly among cancer patients. Clinicians must consistently weigh the benefits of treatment against potential risks in their practice.
There may even be a cost benefit to less lumens and smaller gauge PICC selection. In the study by Ratz et al, it was concluded that hospital policies, who implement strategies to limit the number of PICC lumens, “may enhance patient safety and reduce healthcare costs.”
To summarize, using smaller catheter lumens in PICC lines offers numerous advantages. These include decreased risk of mechanical issues and thrombosis compared to larger lumens, potentially enhancing safety and functionality. Additionally, smaller lumen PICC lines can help reduce occlusion and fibrin sheath formation, common problems with catheter use. While larger lumen PICC lines may have advantages for certain medical assessments, opting for smaller lumens can minimize risks and complications associated with catheter use.
Health Line’s Synergy CT PICCTM XS range consists of 3fr Single Lumen and 4fr Double Lumen catheter kit sizes, giving clinicians the best option to follow and incorporate the best standards of care, prioritizing patient’s pathway to recovery with vessel health and preservation in mind.
References:
Gorski, L. et al. (2021, January) Infusion Therapy Standards of Practice. Journal of Infusion Nursing. https://journals.lww.com/journalofinfusionnursing/citation/2021/01001/infusion_therapy_standards_of_practice,_8th.1.aspx
Bhargava, M. et al (2020, June 4) Risk factors for peripherally inserted central catheter line–related deep venous thrombosis in critically ill intensive care unit patients. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278290/
Casimero, C. et al (2020, August 26) Minimizing Blood Stream Infection: Developing New Materials for Intravascular Catheters. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554993/
Lam, P. et al. (2018, September 15) Impact of Defaulting to Single-Lumen Peripherally Inserted Central Catheters on Patient Outcomes: An Interrupted Time Series Study. Infectious Diseases Society of America. https://academic.oup.com/cid/article/67/6/954/4964802?login=false
Ratz et al. Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study. Infect Control Hosp Epidemiol2016;37:811–817. https://pubmed.ncbi.nlm.nih.gov/27033138/