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Tip of the PICC


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Hi colleagues,

We use PICC in the NICU all the times and seldon have complications. There several emntioned complication from PICC lines, particularly the malpositioned ones. PICC lines at times, as you all know are critical in the management of preemies and it is very improtant to understand risk and benfits of keeping a line when it is placed. I recently seen a couple of radiology report requesting to remove PICC lines because project into the liver.

I though understand that the hepatic vein are very difficult to catheterize with a PICC line (as opposed to umbilical catheter), especially once you have inserted a PICC and is sitting above the diaphragm, if you pull it back, it will be unlikely to retrograde enter in the hepatic veins. I trained to accept PICC as well placed when(those in the lower extremities), the tip lies in the IVC, no kink or bends and at least at or above L4-L5, this ways making sure you went beyong the lumbar veins (common entrance of lower extremity PICCs).

Based on this:

what is you practice regarding PICC tip placement?

any with experience in PICC entering the liver?

Any case report?



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I share your views, that PICC lines in inferior vena cava above L4-L5 is a good position. As we commonly insert PICC lines in the arms, I have less experience with leg sites, but I have not seen a PICC line entering the liver.


When it comes to PICC lines I personally feel that there is sometime a trade-off between a really optimal position and what's possible to achieve for an individual baby. For example - although we aim for an intrathoracic position for a line coming through cubital veins, sometimes the line reaches only the subclavicular vein. Also a reasonably large vessel but not as intended. If the baby is believed to be on parenteral nutrition for a short while or has few/no alternative vessels, we accept that position.

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We use PICC lines extensively in particular the 1 Fr Vygon premicath which is inserted through a conventional 24 G cannula. Its ease of insertion was further improved a few years ago with the inclusion of a guide wire and generally takes longer to secure the line than insert it. The vast majority of our lines are inserted in the leg, the guide wire in my opinion has minimized malposition and as yet we have not seen one enter the hepatic vein. Prior to the guide wire we had a few cases of bizarre paths.


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  • 6 years later...

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