[Daytonite]

Between 1991 and 1996 I inserted PICC lines at the bedside as part of my responsibilities of being on an IV team. From start to finish (confirming placement of the distal tip on a CXR) it took about 4 hours. Yesterday I had a PICC line inserted as preparation to have chemotherapy. Times have changed. The line was inserted in radiology by a RN with a radiologist supervising. They used ultrasound and fluoroscopy. It was all over in about an hour and a half. And, it was totally painless. The radiologist was a great teacher and turned all the monitors to make sure I could see everything. He made a point of showing me how they were using the ultrasound to visualize and track both the basilic and cephalic veins. What a lesson! If only we'd had this equipment 16 years ago! This PICC, I was told, could remain in place for up to a year! No kidding? I love it already. I'm going to christen it with a personalized name.

Anybody know why these kits come with 60+cm-long catheters? It was a question that came up yesterday. I was thinking it was in case they used a more distal site of insertion. Maybe they put these things into horses. Ha! Ha!

[CritterLover]

Originally Posted by Daytonite

Anybody know why these kits come with 60+cm-long catheters? It was a question that came up yesterday. I was thinking it was in case they used a more distal site of insertion. Maybe they put these things into horses. Ha! Ha!

Yes, a more distal site (in some very obese patients, even with a "good" US, distal to the AC will be the only vein to find)....

Or a taller person .....

Or the left arm .....

Or the cephaic vein (usually a longer vein path) ...

Or a combination of the above.

I've used the whole 60 cm length in a few people.

One was a 6'6" young diabetic male. Had to use the left arm cephalic vein. I started up pretty high, but the PICC still didn't quite make the SVC/Ra junction.

Another one was a very obese, short young woman. I had to start below the AC space (though not very far below it), and I think I used the cephalic vein. The catheter tip didn't even make it past the subclavian vein.

We used catheters that could be trimmed, though, so it didn't really matter in the end that the catheter started out being 60 cm, even if the patient didn't need the whole length.

Yes, they supposedly can stay in place for up to a year, though that isn't a hard and fast rule. Longest any of mine stayed in was for 8 months (hospice patient on a pain pump for spinal mets). One of the radiologists I work with recently took one out that had been in for over 3 or 4 years, according to the patient.

We tell patients that it isn't recomended that the PICC stay in longer than a year. However, most docs won't let them stay in that long, and just use them as a bridge until a port can be placed if long term (>3mos) therapy is anticipated.

[Spidey's mom]

PICC Lines are placed by our CRNA or our general surgeon.

The actual placement takes only a few minutes. Then the portable xray comes right in.

The whole thing doesn't take as long as an hour. Maybe because our hospital is small. Xray is just down the hall. So is Lab. And the ER. And L&D.


steph