WordNet

related to the key issue but not of central importance; "a peripheral interest"; "energy is far from a peripheral issue in the economy"; "peripheral issues"
(computer science) electronic equipment connected by cable to the CPU of a computer; "disk drives and printers are important peripherals" (同)computer peripheral, peripheral device
on or near an edge or constituting an outer boundary; the outer area; "Russias peripheral provinces"; "peripheral suburbs"
put or introduce into something; "insert a picture into the text" (同)infix, enter, introduce
introduce; "Insert your ticket here" (同)enclose, inclose, stick in, put_in, introduce
an artifact that is inserted or is to be inserted (同)inset
a folded section placed between the leaves of another publication
in or near a center or constituting a center; the inner area; "a central position"
a workplace that serves as a telecommunications facility where lines from telephones can be connected together to permit communication (同)telephone exchange, exchange
a thin flexible tube inserted into the body to permit introduction or withdrawal of fluids or to keep the passageway open
in or at or near a periphery or according to a peripheral role or function or relationship

PrepTutorEJDIC

周囲の; 周辺（装置）の・末梢的な・重要でない; （...に比べて）瑣末な (to); 【医】末端部の; コンピュータの周辺装置
(…に)…‘を'『差し込む』,挿入する《+『名』+『in』(『into, between』)+『名』》 / 挿入物;(別刷りの)差し込みページ;(新聞などの)折り込みビラ
『中心の』,中央の,中心からの / 『主要な』,中心的な(main) / (音声が)中舌音の / 電話交換局(《英》[telephone]exchange)
カテーテル,(特に)導尿管(体内液の排出・導入に用いる細い管)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/03 19:21:39」(JST)

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Chest X-ray showing tip of PICC line in the superior vena cava

Typical PICC line: Note the manual clamp at top.

A peripherally inserted central catheter (PICC or PIC line) is a form of intravenous access that can be used for a prolonged period of time (e.g. for long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition). First described in 1975,^[1] it is an alternative to central venous catheters such as subclavian lines, internal jugular lines or femoral lines, which have higher rates of infection — subclavian and jugular line placements may result in pneumothorax (air in the pleural space of lung), while PICC lines have no such issue because of the method of placement.

Insertion

Illustration of fully inserted PICC

A PICC is inserted in a peripheral vein in the arm, such as the cephalic vein, basilic vein or brachial vein, and then advanced proximally toward the heart through increasingly larger veins, until the tip rests in the distal superior vena cava or cavoatrial junction.

PICCs are usually inserted by physicians, physician assistants (in the US), radiologist assistants (in the US,) respiratory therapists, nurse practitioners, or specially trained certified registered nurses and radiologic technologists using ultrasound, chest radiographs, and fluoroscopy to aid in their insertion and to confirm placement. PICC insertion is a sterile procedure, but does not require the use of an operating room. When done at bedside (that is, in the patient's room), a suitable sterile field must be established and maintained throughout the procedure. For this reason, visitors are normally requested to leave the room until the insertion is complete, and some form of skin preparation should be used to clean the patient's skin.

The insertable portion of a PICC varies from 25 to 60 cm in length, that being adequate to reach the desired tip position in most patients. Some lines are designed to be trimmed to the desired length before insertion; others are simply inserted to the needed depth with the excess left outside. As supplied, the line has a guide wire inside. This wire is provided to stiffen the (otherwise very flexible) line so it can be threaded through the veins. The wire is removed and discarded after insertion.

The PICC is also provided with a "wing" having holes for either sutures or an adhesive securing device. Securing the catheter prevents post-insertion movements of the line, which otherwise could place the tip in an unsafe position.

Usage

PICCs can remain in situ for extended periods of time, from seven days to 12 months,^[2] although little information is available with respect to viability timeframes. They are used in both the hospital and community settings. PICCs can be used for intravenous delivery of total parenteral nutrition (TPN), chemotherapy, antibiotics or other medications, and can also be used for blood sampling if the lumen is 4 French or larger in size (Arrow and Bard manufacturers guidelines). To maintain patency, PICC management should include regular flushing with normal saline and "locking" with Heparin or normal saline when not in use. The type of locking procedure depends on the type of PICC and bung; Groshong PICCs have a three-way valve at the tip so the use of a heparin lock is not necessary, and there are no clamps on the external length. In comparison, Arrow PICCs have clamps on the exterior line and require a heparin lock. The use of heparin to maintain line patency, though, is questionable, and currently randomized clinical control trials are investigating this further. Heparin locks have been associated with complications, including heparin-induced thrombocytopaenia.^[3]

Other complications may include catheter occlusion, phlebitis, haemorrhage, thrombosis and infection. Urokinase or low-dose tPA (Alteplase or Cathflo) may be used to lyse obstructions. The type of occlusion (caused by medication precipitate or by thrombus) may determine which drug will be used in an attempt to clear the line. To decrease the risk of infection, particularly a blood stream infection, those involved in the management of the PICC must adhere to strict infection control procedures.^[4]

Blood pressure should not be taken on the arm with a PICC,^[5] which is a problem if there are reasons not to take pressure on the other arm, such as a dialysis shunt, absence, cast, infection, lymph node removal, etc. Blood pressure readings on legs are often 10–20% higher than those on the brachial artery.^[6]

Certain types of PICCs have recently been approved by the FDA for use in power injection. These types, often referred to as power-injectable PICCs, are designed to withstand the high pressures associated with radiocontrast studies.

PICCs can also be used to measure central venous pressure, which is a rough estimate of the right atrial pressures of the heart and can give valuable information about fluid status.

Removal

In most cases, removal of a PICC is a simple procedure. Generally, the catheter line can be safely and quickly removed by a trained nurse, even in the patient's own home, in a matter of minutes. After removal, the insertion site is normally bandaged with sterile gauze and kept dry for a few days, during which the wound can close and begin healing. Usually, a smaller adhesive bandage can be placed over the wound site after the gauze is removed if the wound is slow to heal.

References

^ Hoshal VL (May 1975). "Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters". Arch Surg 110 (5): 644–6. doi:10.1001/archsurg.1975.01360110190032. PMID 805577.
^ http://picclinenursing.com/picc_bens.html. Missing or empty |title= (help); Missing or empty |url= (help)
^ [1]
^ Guidelines for the Prenention of Intravascular Catheter-Related Infections, Centre for Disease Control 2011; Infusion Nurses Standards, 2010).Centre for Disease Control
^ U Wisconsin, Preparing and Caring, accessed July 24, 2013
^ Measuring Blood Pressure in Legs, by Erica Brownfield, MD, accessed July 24, 2013

External links

Description and images of PICC line insertion^{[dead link]}

UpToDate Contents

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1. 中心静脈アクセスの概要 overview of central venous access
2. 中心静脈カテーテルの合併症とその予防 complications of central venous catheters and their prevention
3. カテーテル関連の上肢静脈血栓症 catheter related upper extremity venous thrombosis
4. 血管内カテーテル感染症の予防 prevention of intravascular catheter related infections
5. 超音波ガイド下血管アクセスの原則 principles of ultrasound guided venous access

English Journal

Defining peripherally inserted central catheter tip position and an evaluation of insertions in one unit.

Johnston AJ, Bishop SM, Martin L, See TC, Streater CT.SourceJohn Farman Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Anaesthesia.Anaesthesia.2013 May;68(5):484-91. doi: 10.1111/anae.12188. Epub 2013 Mar 13.
Peripherally inserted central catheters are increasingly used to provide access to the central venous circulation. They are commonly positioned 'blind' using a variety of anthropometric techniques and operator experience to direct insertion length. Malposition rates are poorly defined because of dif
PMID 23488895

A Prospective Postmarket Study to Evaluate the Safety and Efficacy of a New Peripherally Inserted Central Catheter Stabilization System.

Egan GM, Siskin GP, Weinmann R 4th, Galloway MM.SourceCommunity Care Physicians, Latham, New York, and Albany Medical College, Albany, New York (Ms Egan); Department of Radiology, Albany Medical Center Hospital, Albany, New York (Dr Siskin); St Paul Radiology, St Paul, Minnesota (Dr Weinmann); and Saint Luke's Hospital, Kansas City, Missouri (Ms Galloway). Gail M. Egan, MS, ANP, is a nurse practitioner with Community Care Physicians and instructor of radiology at Albany Medical College. She is the 2008 recipient of the Suzanne LaVere Herbst Award for Excellence in Vascular Access Practice and a past president of the Association for Vascular Access. Gary P. Siskin, MD, is professor and chairman of the Department of Radiology at the Albany Medical Center Hospital, Albany, New York. Dr Siskin's interests cover all aspects of vascular/interventional radiology. Robert Weinmann IV, MD, is a board-certified radiologist at St Paul Radiology. He holds a BS from the University of Michigan, Ann Arbor, and an MD from the University of Southern California. He has practice experience as an emergency room physician, body radiologist, interventional radiologist, and neuroradiologist. Margy M. Galloway, BSN, RN, OCN®, VA-BC, CRNI®, is a registered nurse and PICC team clinical educator at Saint Luke's Hospital in Kansas City, Missouri. Ms Galloway is board certified in vascular access. She is the president of MO-KanVAN, a local network for the Association for Vascular Access.
Journal of infusion nursing : the official publication of the Infusion Nurses Society.J Infus Nurs.2013 May/June;36(3):181-188.
An initial postmarket study of the SecurAcath used with 5 Fr peripherally inserted central catheters (PICCs) was conducted with 68 adult patients at 3 different institutions in the United States. PICCs were placed in both outpatients and inpatients, with patients in critical care and medical/surgica
PMID 23558917