University Health Care Infusion Services

Vascular Access Services

Pheripherally Inserted Centeral Catheter (PICC)	Midlines
A PICC is a peripherally inserted central catheter that terminates in the vena cava, where a large amount of blood as well as the turbulence of the blood avoids the problem of chemical phlebitis. Peripheral veins cannot tolerate the constant flow of a very hypertonic solutions. PICC’s are used for total parenteral nutrition (TPN), antibiotic therapy, medications, chemotherapy, intravenous fluids and blood draws. A PICC catheter is recommended when IV therapy is required for at least 7 days for those patients with poor venous access.	Midlines are placed in the upper arm using the basilic , brachial or cephalic veins with the tip ending below the level of the axillary line measuring between 5 -10 inches (10-20 cm). This device provides an alternative to the short peripheral IV’s that have to be replaced every 72- 96 hrs and can stay in the arm for up to 4 weeks. The only drugs or solutions that can be safely infused through a Midline are the same drugs that are safe for peripheral IV’s with a pH greater than 5 or less than 9. Continuous vesicants or irritants like chemo, dopamine and TPN that contain more thatn 10% dextrose and medications with extremely high or low pH should not be infused through a midline.
Difficult peripheral IV starts	Difficult blood draws
When called, the PICC team comes to place PIV’s in patients using ultra sound to access deeper larger veins on patient’s.	There are patients that phlebotomy had difficulty drawing blood on. They call us and we come with the ultrasound to gain access and get the blood for testing.