Peripherally inserted central venous catheters

Donaldson JS, Morello FP, Junewick JJ, O Donovan JC, Lim-Dunham J (1995) Peripherally inserted central venous catheters US-guided vascular access in pediatric patients. Radiology 197 542-544... 

Many different types of venous-access devices are available. Peripherally inserted central venous catheters (PICCs), which can be made of PU or silicone, are inserted into a vein in the arm rather than in the neck or chest. Nontunneled CVCs are shortterm catheters, made of PU or silicone as well, inserted into the internal jugular, subclavian, or femoral vein. Tunneled CVCs are long-term catheters implanted surgically under the skin. One end of the catheter remains outside the skin and the exit site is typically located in the chest. Passing the catheter under the skin helps to reduce the infection risk and provides stability. Implantable ports are similar to tunneled catheters but are left completely under the skin. They consist in small devices, made of plastic or titanium, inserted beneath the skin and connected to a catheter allowing vascular access. Under the skin, the port has a septum through which drugs can be injected and blood samples can be withdrawn. 

Al Raiy B, Fakih MG, Bryan-Nomides N, et al. Peripherally inserted central venous catheters in the acute care setting a safe alternative to high-risk short-term central venous catheters. Am J Infect Control March 2010 38(2) 149-53. 

Central venous catheter access results in faster and higher peak drug concentrations than peripheral venous administration, but central line access is not needed in most resuscitation attempts. However, if a central line is already present, it should be the access site of choice. If IV access (either central or peripheral) has not been established, a large peripheral venous catheter should be inserted. Intraosseous (IO) administration is the preferred alternative if IV administration cannot be achieved. 

Catheter device selection is based on a number of factors, including the plarmed application and placement site, duration of implantation, composition of fluids infused, and frequency of access (Namyslowski and Patel, 1999). Vascular catheters can be divided into two genei groups shortterm, temporary catheters that are placed percutaneously, and long-term, indwelling vascular catheters that usually require a surgical insertion. Temporary catheters include short peripheral venous and arterial catheters, nontunneled central venous and arterial catheters, and peripherally inserted central catheters (Pearson, 1996). Tunneled central venous catheters and totally implantable intra-... 

MidUne catheters and peripherally inserted central catheters (PlCC) are inserted in a peripheral vein but the tip rests in a larger vein. The infusion fluid flows directly in the larger vein which diminishes the chance of phlebitis. Both types of catheters are typically inserted in a vein in the upper arm. The midline catheter ends at armpit height the tip of the PICC rests in the vena cava superior. The PlCC may have single or multiple lumens. The PlCC line can be used as a central venous catheter for infusion which needs fast dilution or distribution or both such as antibiotics, pain medicine, chemotherapy, nutrition, etc. 

Long-term central venous access devices used for chemotherapy can be categorized into peripherally inserted central catheters (PlCCs), chest wall external catheters (tunneled and non-tunneled), and subcutaneous ports (chest wall and extremity). 

Hovsepian DM, Bonn J, Eschelman DJ (1993) Techniques for peripheral insertion of central venous catheters. J Vase Interv Radiol 4 795-803... 

Chopra V, O Horo JC, Rogers MA, et al. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults a systematic review and meta-analysis. Infect Control Hosp Epidemiol September 2013 34(9) 908-18. 

In patients with CKD, preservation of the integrity of peripheral and central veins is of vital importance for future hemodialysis access. Avoid i.v. infusion or vein puncture in the forearm and upper arm veins at both arms whenever possible. Insertion of venous access devices carries the risk to injure the veins and thereby incite phlebitis, sclerosis, stenosis or thrombosis and has to be avoided. Whenever a central venous catheter is needed, catheterization of the internal jugular or femoral vein is always preferred. Use of subclavian vein should be... 

The incidence and duration of phlebitis seems to be dependent on a variety of factors. Physical-chemical factors such as low pH, hypertonicity, particles and precipitation play a role in the cause. Active substances that are poorly soluble in water may precipitate and can cause acute phlebitis. Active substances with adequate aqueous solubility may tend to cause phlebitis only because of prolonged or chronic administration. Clinical factors involving injection technique (infiltration, extravasation, type of needle, duration of infusion) but also irritating characteristics of the active substance can contribute to the occurrence of phlebitis [9, 10]. Sometimes (septic) phlebitis is caused by bacterial infection (e.g. cause of inappropriate aseptic technique during catheter insertion) and is characterised by inflammation with suppuration of the vein wall. Local responses to the parenteral challenges can be diminished by dilution of the medicine or by central venous instead of peripheral venous administration (see Sect. 13.10.3). 

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