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PICC Lines in the ICU


Intravascular devices (IVDs) are universally employed for treatment of patients in the intensive care unit. Often multiple lines are used for the administration of medications and intravenous fluids. If peripheral veins are used for this purpose, the catheters must to be changed very frequently. This can often be difficult and at times venous access is not possible because of blockage from repeated puncture and inflammation, inability to palpate or visualize vessels, or from physical conditions relating to the underlying disease or illness. In these circumstances a central venous catheter can prove vital as it may be retained for long time periods and provide multiple accessed via one line. But central lines have their own complications, which can be serious such as a pneumothorax. In these cases a peripherally inserted central catheter (PICC) can prove most beneficial.

The use of peripherally inserted central catheters in intensive care units (ICU) for intermediate to long term venous access has increased steadily and significantly over the past decade. In addition to a significantly longer duration time, studies have shown less incidences of venous inflammation and subsequent blockages. But PICCs should not be expected to replace existing methods of vascular access but, rather, used to provide a safe and effective alternative.

Previously stated, PICCs are generally used for the administration of medications and intravenous fluids. However, they have other uses as well. Patients treated in the ICU typically require repeated blood sampling for laboratory evaluations such as liver function, blood sugar, creatinine, to determine responsiveness of current treatment and patient status. Repeated puncturing to obtain blood samples may not be possible or successful all the time and also is also painful to already sick patients. A PICC may be utilized to draw blood samples for various investigations and thus reduce the number of pricks. Additionally, PICC lines can be used to measure central venous pressure (CVP) necessary for assessing patients with various cardiovascular diseases and illnesses.

Although PICCs in the ICU have many benefits, complications can occur. These complications include like malposition, catheter clotting, bleeding, mechanical phlebitis, arterial puncture and, rarely, infections. Patients with a decrease in immunological function along with other underlying illnesses further increase the risk of PICC related infection.

However, many studies done on PICCs in ICU have found that it is a safer and effective alternative to conventional peripheral catheters and central venous catheters, as well as having an exceptionally high success rate in obtaining IV access. Additional large scale studies would be beneficial to fully determine if they should be the standard of care for regular use in ICU.


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