PICC Use and Care for the Home Patient
Chemotherapy for cancer treatment is increasingly delivered intravenously by boluses or by continuous infusion in both outpatient and home settings. PICCs, accordingly, are becoming the first choice route to deliver long-term chemotherapy, hematology products or total parenteral nutrition (TPN) in cancer patients. PICCs are also used extensively in non-cancer patients who require long-term antibiotics necessary for treatment of such conditions as lyme disease, osteomyelitis, or cellulitis. They can be inserted safely by specially trained nurses, managed easily at home and are associated with very low risks and serious complications compared to other central catheters.
A PICC line is essentially a narrow flexible catheter inserted through a vein of the upper arm above the elbow until its tip reaches a very large heart called the superior vena cava (SVC). Its placement simply consists of one cannulation, which can be carried out in the home at times if necessary. Significant risks of the procedure are minimal. After insertion, the line can remain in place for a few weeks up to a year, depending on many factors, including purpose of use as well as care and maintenance.
PICC lines are quite easily maintained, with dressing changes normally required weekly and flushing lines with one or two solutions at recommended intervals depending on its use and catheter design. Many patients are taught self-care making them less dependent on PICC nursing teams, specialist vascular nurse or home health care providers.
Infection is a constant risk with all intravenous devices. However, the reported rates of infection from PICC lines are relatively low. The risk of thrombosis of arm veins is also quite small, although some hospitals prescribe the anti-clotting agents like warfarin as a precautionary measure.
For minimizing problems associated with PICC lines, guidelines include:
Knowledge of maintenance and care of PICC lines insures long term use. Problems, detected early, greatly decrease any complications that might be associated with this line. It is important to address any concerns with individuals trained in PICC line care.
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