Chapter 32 ■ Central Venous Catheterization 197

removed. Disadvantage: There is a potential for shearing or severing the catheter if it is retracted while the

needle is in the vein.

2. Peel-away introducer (Fig. 32.3): A needle introducer is

used to place a small cannula or sheath into the vein.

The needle is then removed and the catheter is

threaded through the cannula. The introducer cannula

or sheath is then retracted from the vein, split or

“peeled” apart, and removed from the catheter.

3. Intact cannula (Fig. 32.4): This technique is now rarely

used because most commercially available catheters

have a hub and introducer needles. A regular IV cannula is used to obtain venous access. The needle is

removed. The silicone catheter is threaded through the

cannula to its final position. The cannula is then

retracted and slipped off the end of the “hubless” catheter. A blunt needle with hub is connected to the end

of the catheter. Disadvantage: The blunt needle attachment must be secured well, otherwise leakage can

occur.

C. Placement of PICC

1. Equipment

All equipment used, except the mask, head cover,

and tape measure, must be sterile. Commercial kits

contain many of the necessary items. Assemble all supplies before starting procedure.

a. Radio-opaque central venous catheter

b. Break-away or peel-away needle introducer

c. Device for trimming the catheter ( based on manufacturer recommendations)

d. Tourniquet (optional)

e. Drapes

f. Smooth iris forceps

g. Gauze pads

h. Skin prep: 10% povidone–iodine or 0.5% chlorhexidine solution (as per institutional policy)

i. Transparent dressing

j. Sterile tape strips

k. Sterile heparinized saline solution (0.5 to 1 U/mL

heparin or per institutional policy)

l. 5- to 10-mL syringe with needle

m.Tape measure

n. Sterile surgical gown, sterile gloves, mask, and head

cover

2. Preparation

a. Although anesthesia is not required, nonpharmacologic comfort measures and pain medication should

be provided as needed. A small dose of sedative or

narcotic analgesic may be useful.

A B

C

Fig. 32.2. PICC using break-away needle technique. (From

Gesco International, San Antonio, Texas, with permission.)