• Indications​

  • Short to medium-term central venous access for:

    • Blood products 

    • Chemotherapy

    • Inotropes

    • Medications (eg. Antibiotics)

    • TPN

 

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• Contraindications​

  • No available vein access

    • Access site infection 

    • Occluded/thrombosed peripheral veins

  • Occluded central veins

  • In patient with need of longterm central venous access, eg. hemodialysis 

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• Medical History

  • Check

    • Clinical history

      • Pathology

      • Previous venous lines? (PICC, Tunnel/Non-tunnel)

      • Occlusion of central veins?

    • Physical examination 

      • Signs of infection at the access site

      • Assess access site, in history of multiple tunnelled lines

    • ​Procedure indications

      • Verify the duration of the treatment

    • Current medications

      • Any anticoagulant or antiplatelet agents?

    • Allergies

    • Ask For:

      • Written/electronic request for the procedure

      • Is the patient capable to consent?

      • Available venous access?

      • Ask for anesthetic team cover if needed

      • Nil by mouth for 6hr prior to the procedure

  • Imaging Studies

    • CT

      • Assess vascular anatomy​

      • Patent central veins?

    • US

      • Safe access?

    • Ask For:

      • New imaging if needed

  • Laboratory Exams

    • INR (<1.5), PT, aPTT, PLT (>50.000/μL), Htc, HB, WBC, CRP

    • Infectious Status

    • Ask For:

      • Manage anticoagulation (if needed)

      • Optimize blood products (if needed)

  • Medications​

    • Management of co-morbidities  (allergy, blood glucose, blood pressure, nausea, etc)

    • Ask For:​

      • Aspirin: Do not withhold

      • Clopidogrel: Hold 5 days prior to procedure

      • LMW heparin: Withhold one dose before the procedure

 

• Outcomes

  • Technical success rate: >95%

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• Alternative Treatments

  • Radiological: ​

    • Non-fluoroscopic PICC line

      • Bedside PICC, with external estimation of length and tip verification with:

        • Chest X-ray

        • Tip verification system (Sherlock 3CG)

      • Short PICC insertion with the tip at a peripheral vein (Midline)

    • Non-Tunneled line (short-term)

    • Tunneled line (long-term)

  • Surgical placement