Type of publication: observational study
Author: Robert B. Dawson
Systematization of the approach to PICC exit site selection in the upper extremity.
Why this article
Because it represents an important contribution on the importance of standardizing the PICC implantation maneuver starting from the choice of the ideal implantation zone.
The consequences of random PICC practice can be serious and manifest as deep vein thrombosis, pulmonary embolism, catheter related bloodstream infection, and post thrombotic syndrome. Risk factors related to site selection have been well es- tablished for other central venous access devices, but not for ultrasound guided PICC insertion in the upper arm. The author presents observations of upper arm PICC insertion designated by color zones to highlight the variability of PICC practice. The author also details site risk factors associated with each color zone and proposes an ideal insertion location for upper arm ultrasound guided PICC procedures.
The PICC Zone Insertion Method (ZIM) is a proposed system design for patient safety related to PICC insertions; per- formed by optimizing and organizing the clinical approach. It aids in identifying the Ideal Zone for upper arm needle inser- tion with ultrasound guidance. The signi cance of a systematic approach is that it is reproducible, measurable, and as a result will reduce variation in PICC insertion practice. The ZIM combines known mechanisms for vascular access insertion site complications with a systematic measuring and ultrasound scanning process, to reduce the impact of site risk factors. The impact of thrombosis cannot be underestimated, as it will likely limit the future use of veins for life saving vascular access. This issue should not be ignored by hospitals or clinicians, in fact, systematic solutions like PICC Zone Insertion Method, should be explored and supported as part of a comprehensive approach to vascular access care.