A peripherally inserted central catheter (PICC) line is a minimally invasive way to deliver medications to the central venous blood system, usually inserted at the bedside by a specially trained nurse. In the past, a surgeon would have to insert a central line, but the advent of the PICC line has made these almost obsolete. PICC lines are useful in many situations -- for parenteral nutrition and chemotherapy, for example --.but they do have some contraindications to be aware of.
A skin infection at the insertion site is a contraindication for PICC line placement. Any bacteria that is on the skin can easily be introduced into the line and cause a septic infection for the patient. It is better to find another site at which to insert the line to avoid skin that already has a bacterial problem.
Known Central Vascular Occlusions
Anything that is going to impede the easy feeding of the line into the central venous space is a contraindication for a PICC line. For instance, if the patient has an indwelling pacemaker, a PICC line cannot be inserted on the side in which the pacemaker is resident as it would interfere with the insertion of the line and perhaps the functioning of the pacemaker. Anything else that occludes the vasculature is also a contraindication as is any malformation of the heart that may have required surgery.
A dialysis fistula in the intended arm for the PICC line is a contraindication; due to the rerouting of the vasculature of the arm, there is no way a PICC line could successfully be inserted there. Furthermore, it would damage the fistula to attempt to insert a PICC line into it and possibly cause trauma to the surgical graft. A possible contraindication is in patients who have end-stage renal disease, as the upper extremity may need to be preserved for future fistula usage; it is important to weigh the risks versus the benefits in such cases.
Mastectomy and Lymphedema
A PICC line cannot be inserted in the arm on the side on which a female has had a radical mastectomy with lymph node dissection. Similarly, if the patient has any evidence of further lymph problems, such as lymphedema, then the PICC line cannot be inserted into that arm, as the lymph system is faulty and unable to drain, so inserting a PICC line may lead to further complications.
If a patient has a bacterial condition known as sepsis, then a PICC line should not be inserted until the blood cultures come back negative. This is because of the nature of the PICC line insertion; a patient who is already suffering from too much bacteria in the blood is at greater risk for infection and attendant complications.
The presence of any blood coagulating disorder is a contraindication for PICC line insertion. If a patient is at risk of bleeding too much, then inserting a line at the bedside may turn into a critical situation. Likewise, if the patient clots too much, then the risk of the patient getting a clot in the arm is great; such a clot can easily travel to the lungs and cause a life-threatening medical condition called a pulmonary embolism.
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