Just what is a PICC Anyway?
When hearing a patient needs a peripherally inserted central catheter (or PICC) chances are they (or their loved one) are already suffering from one of several critical illnesses. PICCs are commonly thought of when a patient has cancer, kidney disease, or in the case of premature infants. The PICC is used as long term option when a regular intravenous catheter would be in a state of constant replacement.
How long have we been using PICCs and what are the different options?
The first documented case study for PICC was in 1996 (World Journal of Critical Care Medicine) and PICC options have changed immensely in that short 20 years. PICCs currently vary in material makeup. The newest material currently used is polyurethane, and the older being silicone. Both types are still in use today. Some have one lumen, others have three, (also commonly known as triple lumen) PICC vary in size from 3-6 French. Additionally, some PICCs are capable of delivering up to 300mL/min in critical patients.
How and where are PICCs placed in patients?
This is where the research gets very interesting. The truth of the matter is there are two methods to discuss. The first method is commonly known as the “blind” method where the catheter line is threaded by feel through a vein the arm and into the superior vena cava of the heart. The second method is accomplished using ultrasound technology to guide the catheter up through the arm and into the heart chamber.
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Lewis et al. explain in Medical-Surgical Nursing, a central line is a catheter placed into a large blood vessel for a patient who requires frequent or long-term access to the vascular system. The authors explain that catheters are used for the administration of high volume fluids, medications that are irritating (such as chemotherapy), long term pain medication, blood products, parenteral nutrition, and hemodialysis. Kaiser policy states four different types of central line used for patients: Centrally inserted catheters, peripherally inserted catheters, injection implanted ports and hemodialysis catheters. Centrally inserted catheters
A Foley catheter is a thin, sterile tube inserted into the bladder to drain urine ( ). There are many types of catheters such as a straight, indwelling, and condom catheters. A straight catheter is one that does not stay inside the person. It is removed immediately after urine is drained. An indwelling catheter is one that stays inside of the bladder for a period of time. And last, a condom catheter is one that has an attachment that fits onto the penis. This catheter is changed daily or as needed. For the purpose of this document, the care that is going to be performed will need to be performed on a patient/resident with an indwelling catheter.
Usually, accessing vascular structures is done through a needle to puncture the vessel percutaneously, followed by a wire introduced through the needle to secure the vascular access. The needle is then removed and a sheath is advanced over the wire. Vascular sheaths are hollow structures with a built in diaphragm to prevent bleeding. Catheters are then placed into and out of the sheath with a minimal loss of blood.11
Medical staff will clean and shave your groin or arm for the insertion of the catheter. A local numbing agent will be administered, but you will be awake during the procedure. Medicines for anxiety could be given if patient is having trouble relaxing during the exam. Next, a small catheter will be inserted into an artery. The doctor then uses x-rays to guide the catheter to the area of interest. Once the catheter is in place, dye will be inserted through tube. This allows for visualization of your blood vessels. Very minimal movement will be aloud during this exam to ensure safety and high quality images. This procedure could last one to two hours. If this is a planned procedure and not an emergency, this is normally only scheduled in the
A midline catheter is a thin, flexible tube that is inserted into a vein in the upper arm or at the bend in the elbow. Its tip ends at or near the armpit (axillary) area. A midline catheter is a type of intravenous (IV) access.
In reviewing Heparin flushes in Central Venous Catheters (CVCs); one must first understand the importance of their placement. To properly investigate central venous catheter (CVC) care; documentation will focus on Heparin flushes as it relates to renal care. The renal dialysis patient undergoes CVC placement as a basis of receiving hemodialysis treatments. It is essentially the first access point placed in preparation of a more permanent access point. Central venous catheters, fistulas, and grafts are considered the lifeline of a dialysis patient. Their function and patency is of the utmost importance to the morbidity and mortality rate of a renal patient. “Venous catheters generally develop a fibrin sheath at the tip, which evolve into a clot due to body’s physiological response to the vein injury and the foreign catheter 1 and subsequent catheter obstruction.” (Journal of Evolution of Medical and Dental Sciences, 2014, pg. 46).
These devices directly connect the intracranial space to an external pressure transducer via saline-filled tubing. The bedside pressure transducer must be positioned at the level of the foramen of Monroe (external auditory meatus) to accurately reflect ICP. The catheter is usually connected to both a
The materials used to make up the PICC line is silicone or polyurethane and has a radiopaque measuring 50-60 cm in length with the outside diameter of 2-7 French. The catheter appearance can also vary; it may have a single-or double-lumen or it can have an open-or closed end. The specific device should be selected based on the number of lumens necessary for treatment, being aware of the probable infection increases with the number of lumens. The most common used PICC line is the 5-FR, double lumen, which is a closed-ended
His work led to the evolution of radiofrequency energy catheters, which use radiofrequency energy to heat the catheter tip and perform a more precise ablation than what was possible with direct current ablation. (UCSF.(2012). When cardiac ablation is performed the surgeon is targeting the diseased conductive tissue once this is done, this will assist in correcting atrial fibrillation within the heart. These surgeries can be either minimally invasive or require an open surgical approach. Cardiac ablation is achieved through a cardiac catheter this delivers radiofrequency energy or cryoenergy to the defective area this is considered to be a minimally invasive approach. The electrophysiologist will insert a catheter into the femoral vein/artery and threads it to the right or left atrium and ventricle. They will then test different areas of the heart to try and reproduce dysrhythmia upon doing this they will then ablate the area of the heart where the disturbance takes place. Another alternative would be an open surgery known as a sternotomy approach this is where a midline incision is made in the sternum of the chest. Cannulation of the superior and inferior vena cava will then take place for a cardiopulmonary bypass. The surgeon will occlude the ascending aorta and infuse cardioplegic solution into the coronary arteries. Once this is done a right and left atriotomy is performed and the targets are ablated. The atriotomies are closed, the aorta is unclamped, cardiopulmonary bypass is stopped, cannulas are removed, chest tubes will be inserted at this time and the surgical wound is closed. Upon completion of the surgery the patient is taken to the PACU and monitored for heart rhythm issues as well as, bleeding, infection, or any other complications from the procedure. ( Fuller, J. (2013).(p.922). There are
The researchers’ goal was to compare an antimicrobial PICC line impregnated with CHG with a non-CHG-impregnated PICC line with the development of CLASBI or VTE development among the three-high risk patient population that included immune suppressed, trauma and critical care patients. The overall conclusion shows that there is no significant difference with the use of the two types of PICC in the development of CLASBI or VTE. Statistics does support that increased catheter size impacts VTE formation and those PICC lines that were impregnated with HCG did result in more post insertion bleeding. One conclusion supports that the actual care of the PICC line more so than the type of PICC line used may impact development of CLASBI. The limited
Patients who are expected to have long hospital stays and extensive IV therapy are likely to receive a peripherally inserted central catheter (PICC). PICC lines have been found to be a relatively safe and cost effective route to administer long term intravenous (IV) medications such as antibiotics, chemotherapy and total parenteral nutrition (TPN). These devices are most often inserted at the patient’s bedside by nurses who have received advanced training in the placement of PICC lines. Evidence based practice for sterile technique during insertion has been established and as a result, infection rates remain relatively low. There is one going debate, however, as to the safety of these catheters in patients who are at an increased risk
Catheter is a flexible tube made of latex, silicone, rubber or plastic (PVC) that can be inserted into the body creating a channel for the passage of fluid for the entry of a medical device. Now-a-days, there are many specialized catheter designs. For example, specific catheter designs allow catheters to be used in pulmonary, cardiac (vascular), neonatal, central nervous system, and epidural tissues. Catheters are designed to perform tissue ablation (tissue removal) and even serve as conduits for thermal, optics, and various medical devices. The three major types of catheters are Indwelling (Foley) catheters, External (condom) catheters and Intermittent (short-term) catheter.
To perform a cardiac catheterization the cardiologist will insert a sheath, or a short tube usually into the femoral artery. A long very thin catheter will then be fed through the sheath and guided through the arteries until it is in the heart and coronary arteries. The physician uses fluoroscopy equipment to guide the catheter into the coronary arteries. To allow for clear viewing of the coronary arteries, contrast material is injected into the catheter. As the contrast material flows through the heart chambers and coronary arteries x-rays are taken. The
Cardiac catheterization a long flexible thin tube place in blood vessel in arm, groin, or neck looks in coronary arteries. Dye can be added to see how well the heart is pumping.