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Peripherally inserted catheter (PIC) placement involves the insertion of a long soft catheter (tube), usually used for drug or fluid infusion, into a peripheral (arm) vein using image guidance. The tip of the catheter is positioned in a large vein near the heart.
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PIC provides an excellent alternative to CVL (central venous line) for venous access for drug or fluid infusion. PIC may be placed into the superficial veins at the elbow without image guidance by specially trained nurses and anesthesiologists. The advantage of PIC placement in the Radiology Department is that image guidance can be used to place the line directly into a vein above the elbow. In this way, the catheter does not interfere with elbow movement. The use of imaging such as x-ray fluoroscopy also facilitates precise placement of the catheter tip in the desired central vein. Interventional radiologists at Children's Hospital Boston are trained in the use of image guidance for placement of catheters and other devices. Our radiology technologists and nurses are trained in appropriate care of patients undergoing these procedures.
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Your referring doctor will determine when a central venous catheter is indicated and will take part in the decision regarding the indication for PIC placement. In general, PIC is an option for patients who need prolonged treatment with intravenous fluids or drugs and who do not need a large catheter for this purpose.
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PIC placement is a safe procedure. The procedure does lead to some discomfort during the initial passage of the needle but this will be minimized by the use of local anesthesia (numbing medication). Possible risks or side effects will be explained before you give your consent.
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You will be given instructions in advance of the procedure. The patient may be asked to stop eating solid food eight hours before the procedure and to stop drinking clear fluids three hours before the procedure.
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The interventional radiologist localizes the vein to be catheterized either by using an ultrasound probe or by injecting contrast medium into a vein in the patient's hand. The skin over the area to be catheterized is cleaned with an iodine solution and drapes are placed over the arm and body to prevent infection. A small injection of local anesthetic (numbing medicine) will be made where the needle is to be placed. A needle is then passed through the skin into the vein. Once the needle enters the vein, a guide wire is passed through the needle. This wire is used to guide the soft catheter further into the vein. Once the tip of the catheter is placed in the desirable location, it will be secured to the skin with a bandage.
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By using image guidance (either ultrasound or x-ray with contrast injection), the interventional radiologist can confirm that the vein is open. Because the vein above the elbow cannot be felt through the skin, image guidance is necessary to minimize the number of needle passes and to avoid placing the needle into the artery or another structure. The use of the x-ray monitor also permits the interventional radiologist to make sure that the tip of the catheter is placed in the best possible location before securing it.
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The interventional radiologist will inform you of what was done and how the procedure went as soon as the procedure is over.
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Further information can be obtained by calling Children's Interventional Radiology Office at 617-355-6579. The appropriate person will return your call and answer your questions.
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Peripherally Inserted Catheter Placement
