1. 外科醫學會 消化系外科 周邊置入中央靜脈導管-台北醫學大學附設醫院初始經驗 陳嘉哲1 湯堯舜1 陳瑞杰2 黃宏昌1
陳嘉哲1 湯堯舜1 陳瑞杰 黃宏昌1
台北醫學大學附設醫院 外科部 急外科1
消化外科2

2. Topic Venous access device introduction.
Indication for PICC insertion.
Why do we choose PICC?
PICC in our hospital.
Limitation and Future.

4. Vascular Access Devices

5. What Is PICC ? 1. PICC: Peripherally inserted central catheter
First described in 1975
2. Long vascular access devices ( > 30cm)
from peripheral veins of upper arm
Tip in cavo-atrial junction (CAJ)

7. Indication For PICC Appropriate:
Early Assessment. Right device, Right patient, Right time.
Duration of infusion
Infusate: osmolality (>600 mOsm/L)and pH<5 or pH > 9 (irritant)
In Taiwan: TPN for four weeks and chemotherapy.

8. Indication For PICC

9. Duration
Annals of Internal Medicine Vol.163, September 2015

10. Why Choose PICC ? Infiltration Infusional phlebitis Dopamine
Amiodarone

11. Why Choose PICC ?

12. PICC In Our Hospital Member (Total 3 doctors, one assistant)
Indication
Our checklist
Ultrasound-guided insertion
Chest x-ray for tip position
follow-up?

13. PICC In Our Hospital Visit patient:
> Medical record including port-a, A-V shunt, pacemaker, and past surgical history (MRM), Lab data: platelet, PT, APTT
> Patient’s condition: Fever?, forearm condition. Indication and explanation of the procedure.

14. Medication 7.4 5.3—6.3 Drug pH (N=7.32-7.45) mOsmol/L (N ~ 300)
Discipline
Acyclovir
316
Infectious disease
Amiodarone
4.1
Cardiac/ CCU/ ICU
Ampicillin 9
400
Azithromycin
280
Bactrium 10
541
Caspofungin
6.6
Ciprofloxacin
285
Dobutamine HCL
3.5
Dopamine HCL
3.3
277
Erythromycin
291
Foscarnet
7.4
271
Ganciclovir 11
320
Imipenenem
310
Iron Infusion/ dextran
2000
Anaemia/ CKD
Meropenem
300
Morphine sulphate 4
295
Pain management
Parenteral Nutrition
5.3—6.3
>600 >800
Intestinal failure
Phenytoin 12
312
Neuro
Potassium HCL 5
( mEq/ml)
General
Vancomycin

15. Duration
Annals of Internal Medicine Vol.163, September 2015

16. PICC In Our Hospital Preparation CVC bundle Hat and mask.
Hands washed.
Alcoholic 2% chlorhexidine .
Sterile gloves, gown and full draping.
Right insertion side.

18. PICC In Our Hospital Ultrasound machine for insertion guide
Ultrasound machine check IJV after insertion

19. PICC In Our Hospital
Final tip position
All confirmed by chest X –ray

20. X-RAY

21. Checklist

22. Follow-up 1. Infection rate total
PICC (1.43 / 1000 catheter day), CVP (4.04 / 1000 catheter day), Port-a (2.81 / 1000 catheter day )

23. Collection Data

24. Collection Data

25. Limitation Of The Collection
Infection rate collection (tip culture or clinical sign).
Patient’s follow-up.
Other complication collection including venous thromboembolism.

26. Future When and why removal of PICC.
Outpatient department for follow-up
feedback
May add criteria for PICC insertion

27. Thank you