President/CEO/Clinical EducatorRadiology Physician Associate

General & Interventional TechnologistBoard Certified Vascular Access Specialist

Southern California Vascular Access, Inc. strictly follows The Association for Vascular

Access and Centers for Disease Control guidelines for ALL PICC, mid-line & PIV

line insertions and maintenance.

Peripheral IV’s are inserted with use of Near Infrared Imaging Guidance

Peripherally inserted central catheter (adult) – is inserted peripherally within the Basilic, brachial or cephalic vein with distal tip location in the lower 1/3 of the Superior Vena Cava.

Mid-line placements – is inserted peripherally within the Basilic, brachial or cephalic vein with distal tip location within the Axillary Vein.

Mid-lines are considered peripheral IV’s but with a longer dwell time.

For Mid-lines the PH of vesicant MUST be between 5 – 9 and Osmolarity less than 600 mOsm.

No TPN or PPN infusions via mid-line.

Written physician order for PICC insertion. Must include use of 1% Xylocaine for anesthesia not to exceed 20cc’s.

Order for anxiety meds if patient agitated, or unable to follow instructions of insertion team.

Patient or Immediate family signed informed consent for procedure.

If no family, conservator or 2 physicians sign consent. AP Chest radiograph order for proper tip location prior

to first use. PT/PTT/INR within 10% of normal limits. Normal Ultrasound evaluation of bilateral upper

extremities. (Radiology report) includes vein measurements (diameter). MUST have proper vein to catheter ratio for insertion.

Relevant information from History and Physical.

Inadequate peripheral access, need for reliable access. Need for infusion therapy of usually 5 - 7 days or more with Irritating vesicants: Dopamine/Dobutamine/Vancomycin/Phenergan Complications with peripheral access, multiple failures within 24

hours. TPN or PPN administrations or other solutions that can be irritating

to veins. Open chest wounds, burns, existing tracheotomy or injury's to chest

or neck. Need for CVAD’s with low platelet levels, or other bleeding

problems. Patients who may be a poor general anesthesia risk for other CVC’s. Dermatitis or other skin conditions that would preclude chest access

with a central line. Infections with a previous central line, PICC’s may be a lower risk

option

Conditions that increase the risk of complications to the patient:

Inability to adequately visualize veins or inadequate size.

Peripheral neuropathy, circulatory impairment, CVA or radiation to the insertion site or intended path of the catheter.

History of thrombosis. You cannot place PICC line in known or suspected thrombosis.

Mastectomy, fistulas, grafts and surgically implanted devices. ie; pacemakers, mediports.

Dermatitis, hematomas, burns that would prevent access.

Sepsis. If a patient has a positive blood culture, it may be indicated to treat the patient with peripheral or oral antibiotics for 48 to 72 hours and have a negative blood culture before a PICC is placed.

There are no absolutes with PICCs: Contraindications are best documented in the

patient record to reflect nursing and physician awareness.

Knowledge of the contraindication is used to consider the safest type of vascular access for the patient.

Limitations and contraindications require the healthcare professional/team to pause in thought, give consideration to possible complications and if necessary, proceed with the PICC Line insertion with caution.

At the conclusion of the PICC insertion a report from the PICC

Team will be generated and faxed to your facility for placement on

patients chart.

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