ESTABLISHING AN ULTRASOUND-GUIDED PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) INSERTION SERVICE

Peripherally inserted central catheters (PICCs) are an increasingly us ed means of medium to long-term intravenous access. We have establishe d an ultrasound (US) guided PICC insertion service at our institution that has largely replaced blind bedside insertions, One hundred and si x PICCs were inserted in the upper arms of 89 patients, over a 6-month period with a 100% success rate. The technique for US guided vein pun cture and guidewire insertion is described. Catheter related complicat ions included infection (6 proven cases; 3.1 infections per 1000 cathe ter days); catheter blockage (7), breakage (8) and unintentional remov al (5), Catheter blockage, breakage and partial unintentional removal are potentially remediable complications using guide-wire techniques u nder fluoroscopic guidance. The management of catheter related infecti on is discussed. We have encouraged early communication with our clini cal colleagues in order to facilitate the management of such complicat ions and minimize unnecessary catheter removal.