Peripherally Inserted Central Venous Catheters

Abstract

Percutaneously inserted central venous catheters (PICCs) have become the standard of care for long-term vascular access, both for in-hospital patients and outpatients. Indeed, PICCs have gained increasing popularity in the critical care and perioperative setting in recent years. Thanks to ultrasound-guided insertion techniques, PICCs provide central venous access at a cost near to peripheral venipuncture. Current tip-tracking technology allows precise tip positioning at the bedside without the need for fluoroscopy. For these reasons, bedside PICC insertion is gaining interest within the anesthesiology community and is foreseen as soon becoming part of the anesthesiologist’s regular armamentarium. Peripherally Inserted Central Venous Catheters offers a complete state-of-the-art review on all aspects of PICC insertion and management, from the history of venous access to the psychosocial impact and medicolegal implications. The book is edited by two surgical oncologists from the University of Turin, Italy who have been leading several popular international courses and conferences on this topic. The aim of the text is to provide an in-depth analysis of each aspect of care related to PICCs, and although the final result is a rich compendium, the reader must often sort through an abundance of unprocessed information in order to reach the relevant points. That being said, the book is divided into 15 chapters assigned to a variety of international authors – mostly from Italian institutions – as well as some industry representatives. A thorough historical overview of vascular access is the topic for the opening chapter. This is followed by a very technical discussion on catheter technology and materials, including a helpful review of the biochemical basis of phlebitis. Chapter 3 is the first of a series of three chapters on indications of PICC insertion, and it offers an introduction to the ‘‘proactive’’ approach to venous access for best patient outcome, as theorized by P. Blackburn. Chapter 12 completes the block of chapters on indications and clinical decision-making. As a group, Chapters 6-8 and 11 constitute a practical handbook on PICC insertion and troubleshooting. Chapters 6 and 7 present a step-by-step guide for vein selection, ultrasound scanning, and catheter positioning using different navigational devices. Numerous diagrams and images of a complete series of real clinical scenarios and state of the art equipment complement the well-written text. Chapter 8 comprises a very practical and comprehensive guide to the diagnosis and management of PICC occlusions, though Chapter 11 is of questionable practical value. Chapters 9 and 10 provide a comprehensive review of PICC complications, including an up-to-date literature review on PICC infection and vein thrombosis. Chapter 13 is dedicated to the often underestimated aspect of psychological implications and offers a very detailed well-referenced analysis of vascular access in the oncological patient. Medicolegal concerns related to PICCs, including the need for informed consent and physician supervised vs independent nurse-led teams, are also discussed. Chapter 14 may have limited relevance for North American readers, however, as it comprises a detailed review of the theory of medical malpractice in Italy. A well-written comprehensive review of the PICC team completes this book. All relevant aspects of PICC team M. Meineri, MD (&) Toronto General Hospital, University Health Network, Toronto, ON, Canada e-mail: massimiliano.meineri@uhn.on.ca