Académique Documents
Professionnel Documents
Culture Documents
INDICATIONS
PICC lines are suitable for many situations when access is limited or expected to the
last longer than 2 weeks and also allows for easy blood draws where appropriate
indications include:
Compromised/inadequate peripheral access
Infusion of hyperosmolar solutions with high acidity or alkalinity (e.g. Total
Parenteral Nutrition’s)
Infusion of vesicant or irritant agents (chemotherapy)
Short- or long-term intravenous therapy (e.g. Antibiotics)
CONTRAINDICATIONS
Previous upper extremity venous thrombosis (DVT).
Trauma or vascular surgeries at or near the site of insertion.
Presence of a device related infection or bacteremia at or near the insertion site.
Lymphedema
Allergy to materials.
CAUTIONS
Always use aseptic techniques during catheter and use.
Never leave the catheter uncapped. Always apply sterile cap.
Never use acetone or taper remover on or near the catheter; these can dissolve
the catheter.
Blood pressure measurements should be avoided on limbs with PICCs.
DAILY ASSESSMENTS
1. Assess insertion site for bleeding, exudate, leakage, redness.
a. Upper limbs should be compared for temperature and edema when PICCs.
2. Assess catheter tubing assess for migration, malposition, kinks and cracks.
3. Assess dressing. Inspect that the securement and dressing is dry and intact and
the change due date is clearly visible.
POSSIBLE PROBLEMS
You may get infection
The line may get blocked
A blood clot can develop
A PICC line may split.
The line is flushed regularly with heparin or salt water (saline) to clean the line and
prevent clotting.
REMOVAL OF PICC
In most cases the removal of PICC is a simple procedure. Generally, the catheter
line can be safely and quickly removed by a trained nurse, in a matter of minutes.
After removal, the insertion site is normally bandaged with sterile gauze and kept
dry for a few days, which the wound can close and begin healing.
The tip of the catheter is sent to Microscopy culture and sensitivity.
.
PULMONARY ARTERY CATHETHERIZATION
INDICATIONS
Not indicated as routine pulmonary artery catheterization in high risk cardiac and non-
cardiac patients.
Indicated in patients with cardiogenic shock during supportive therapy
Indicated in patients with discordant right and left ventricular failure
In patients with severe chronic heart failure requiring inotropic, vasopressor and
vasodilator therapy
Indicated in patients with suspected “pseudo sepsis”
In some patients with potentially reversible systolic heart failure
Indicated for the hemodynamic differential diagnosis of pulmonary hypertension
CONTRAINDICATION
PRECAUTIONS
Catheter may need to be re floated
Ensure that the wedging syringe has not been left full of air and accidentally been
inflated
Do not attempt to inflate or flush a wedged balloon.
Check pressure scale and waveform
If catheter is wedge ensure balloon is deflated and pull catheter back 1-2 cms
Reassess trace
Balloon rupture:
There should be slight resistance when inflating balloon.
If there is no resistance and no wedge trace assume that the balloon has a
ruptured and alert registrar for removal and re-insertion