PICC vs. Midline

“VENIFACTS” NEWSLETTER

 WHAT IS A PICC/MIDLINE?

PICC stands for Peripherally Inserted Central Catheter. In other words, it is a central line that is placed via the peripheral vasculature. Midline is a shorter version of the PICC. It is inserted in the same fashion, but it terminates in the axillary veins rather than in the central circulation.

Tip placements of the PICC:

·        Midline – shortest version of the PICC. Its tip terminates in the axilla. Blood flow past tip in this locate equals approximately 90 ml per minute.

·        Midclavicular – this tip terminates in the subclavian near the center point of the clavicle.

·        PICC – longest version. Its tip terminates in the superior vena cava. Blood flow past tip in this location equals approximately 2000 ml per minute.

Note: Midclavicular placement has been know to increase the risk of thrombophlebitis and is avoided if possible. TPN should not be infused through this placement unless you have a written order from the physician since infusing TPN here increases the risk of thrombophlebitis even more.

CATHETER INFORMATION BY TIP PLACEMENT:

Midline placement

·        For IV therapy which will last 2 weeks or less.

·        The medication or IV fluid should not be a vesicant or severe irritant.

·        Complications of this tip placement will include redness and irritation at the location of tip termination, usually in the axilla area.

This is actually a peripheral vein, one of the largest peripheral veins, but is treated like a central line.

PICC placement

·        For long term IV therapy, usually greater than 2 weeks and lasting for even years.

·        Medication will exit into a very large vessel and be passed by approximately 2000 ml of blood every minute.

·        This is the best placement for any vesicant or irritating solution and the only place for central formula TPN.

POINTS TO PONDER

·        Know what kind of catheter the patient has.

·        Read the information printed on the lumens of the catheters. Catheter gauge is imprinted on the pigtails of the catheters for your reference.

·        Use the smaller lumen for continuous fluids and leave the larger lumen for blood draws.

·        Once a catheter is placed, it is very important to maintain its tip position by securing the catheter well.

·        Be sure the hub (or the heaviest portion of the external catheter) is well secured under the dressing. This will prevent catheter migration.

·        Tip position may not always be adequate for the solution you are infusing. A PICC must remain a PICC when infusing central formula TPN or damage to the vascular is possible.

WHO SHOULD YOU CONSULT?