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  • Recommendations from a formalized expert consensus

    Good practice and risk management for the use of PICC (Peripherally inserted central catheter) December 2013

  •     GOOD PRACTICE AND RISK MANAGEMENT FOR THE USE OF PICC - 2014    1  

    Good practice and risk management for the use of PICC (Peripherally Inserted Central Catheter)

    Recommendations from a formalized expert consensus

    Participants ............................................................................................................................2

    Main abbreviations ................................................................................................................4

    Preface..................................................................................................................................5

    Foreword ..............................................................................................................................6

    Methodology..........................................................................................................................8

    Recommendations Indications for the use of PICC........................................................................................10 Insertion of a PICC.........................................................................................................12 Cleaning and use of PICC ..............................................................................................14 General policy aspects ...................................................................................................20

    Rationale Question 1 - Characteristics of PICC catheters .................................................................23 Question 2 - Risks associated the use of a PICC ..............................................................27 Question 3 - Indications for PICC ....................................................................................42 Question 4 - Prevention during PICC insertion ..................................................................54 Question 5 - Maintenance and use of PICC......................................................................62 Question 6 - Surveillance, training and follow-up of PICC...................................................76

    Appendices Appendix 1 - Drawings showing the different setups for PICC utilisation ................................ 89 Appendix 2 - Explanation of the Grade Method for critical analysis of the literature ................ 91 Appendix 3 - Tables of results from the Grade analysis .......................................................... 94

  •     GOOD PRACTICE AND RISK MANAGEMENT FOR THE USE OF PICC - 2014    2  

    Participants

    Invited societies  AFITCH-OR French association of nurses for cellular and hematology therapy, oncology and radiotherapy  FNEHAD National federation of home hospital establishments  FNI National federation of nurses  SFAP French society for the accompaniment of palliative care  SFAR French anesthesia – critical care society  SFM French cystic fibrosis society  SFNEP French clinical and metabolism nutrition society  SFP French pediatrics society  SFR French radiology society  SPILF French language society for infectious pathology  SRLF French language society for critical care  UNICANCER National federation of cancer control centers

    Working Groups

    Coordination (SF2H) Chaize, Pascale healthcare hygiene executive, Montpellier Hygiene Lucet, Jean-Christophe physician, GH Bichat – Claude Bernard, Paris Hygiene Savey, Anne physician, South East CClin, HCL, Lyon Hygiene

    Methodology (SF2H) Blanchard, Hervé physician, Paris-North CClin, Lyon Hygiene

    Referent expert Douard, Marie-Cécile physician, St Louis Hospital, Paris Intensive care - Anesthesia

    Project leader N'Guyen, Sophie pharmacist, Annecy regional Hospital Hygiene

    Documentalist Sanlaville, Nathalie documentalist, South East CClin, HCL, Lyon NosoBase

    Pilot group Adjamagho, Béatrice health care executive, Paris FNEHAD Barnoud, Didier physician, Paris SFNEP Dane, Monique health care executive, Paris AFITCH-OR Lemerle-Saulpic, Juliette physician, Paris SFP Lepape, Alain physician, Lyon SFAR Lurton, Yves pharmacist, Rennes hospital pharmacy Nové-Josserand, Raphaele physician, Lyon SF cystic fibrosis Novelli, Luigi physician, Paris SFR Pottecher, Béatrice physician, Strasbourg UNICANCER Rammaert, Blandine physician, Paris SPILF Soufir, Lilia physician, Paris SRLF Tisserand, Philippe nurse, Paris FNI

  •     GOOD PRACTICE AND RISK MANAGEMENT FOR THE USE OF PICC - 2014    3  

    Expert raters Dupont, Christian nurse, Paris SF cystic fibrosis Grau, Delphine pharmacist, Montpellier Hygiene Kriegel, Irène physician, Paris Intensive care - Anesthesia Lasheras-Bauduin, Agnès pharmacist, Bordeaux Hygiene Marcy, Pierre-Yves physician, Nice CLCC Novakova, Ivana nurse, Paris CClin-Arlin Tequi, Brigitte physician, Nantes CLCC

    Expert raters Albert, Odile nurse, Paris AFTITCH-OR Berger, Pierre physician, Marseille CLCC Borgey, France physician, Caen CClin-Arlin Burgel, Lydie health care executive, Montpellier Hygiene Castan, Bernard physician, Ajaccio SPILF Chabrot, Pascal physician, Clermont-Ferrand SFR Dewas, Caroline nurse, Lompret FNI Duchamp, Anne nurse, Lyon SFNEP Guillaume, Maryse nurse, Castres FNI Heraclide-Houlbert, Bénédicte nurse, Tours FNEHAD Joly, Francisca physician, Paris SFNEP Mimoz, Olivier physician, Poitiers SFAR Rosay, Hervé physician, Lyon CLCC Saint Raymond, Christel physician, Grenoble pneumology, transplantation Toutain-Rigollet, Agnès pediatrician, Lyon pediatrics / cystic fibrosis Vuotto, Fanny physician, Lille SPILF

    Reading group Baghdadi, Nouara nurse, Lille Hygiene Barlogis, Vincent pediatrician, Lyon SF pediatrics Chambrier, Céclie physician, Lyon FNSEP Claisse, Jean-Pierre nurse, Paris AFITCH-OR Desruennes, Eric physician, Villejuif SFAR Erb, Martine healthcare executive, Lille SF2H Esperou, Hélène physician, Paris UNICANCER Keïta-Perse, Olivia physician, Monaco SF2H Laval, Guillemette physician, Grenoble SFAP Lebras, Yann physician, Bordeaux Radiology Legout, Laurence physician, Turcoing SPILF Magne, Nicolas physician, St Priest en Jarez SF oncology Manuel, Clara nurse, Paris AFITCH-OR Migueres, Brigitte physician, Paris FNEHAD Quetant, Sébastien physician, Grenoble SF cystic fibrosis Renaud, Bernadette nurse, Lyon FNEHAD Schneider, Stéphane physician, Nice SFNEP Souweine, Bertrand physician, Clermont-Ferrand SRLF Timsit, Jean-François physician, Grenoble SRLF Zahar, Jean-Ralph physician, Paris SF2H

  •     GOOD PRACTICE AND RISK MANAGEMENT FOR THE USE OF PICC - 2014    4  

    MAIN ABREVIATIONS

    ABP Alcohol based product BAC Bacteremia associated with a catheter CCC Cancer control centre CDC Centres for disease control and prevention

    CLABSI Central line associated bloodstream infection CRB Catheter-related bacteremia (BLC in Fr) CRI Catheter related infection

    CVC Central venous catheter DVT Deep venous thrombosis

    Fr French GPR Good practice recommendations HAS French National Authority for Health

    HH Home hospitalisation HMC Hospital medical commission ICU Intensive care unit MA Moderate agreement

    PICC Peripherally inserted central catheter PN Parenteral Nutrition

    PVC Peripheral venous catheter SA Strong agreement SU Single use

    TIVC Totally implantable venous catheter

  •     GOOD PRACTICE AND RISK MANAGEMENT FOR THE USE OF PICC - 2014    5  

    Preface

    ighteen months after publishing a volume describing the "Prevention of infections associated with totally implanted venous catheters", the

    present recommendations deal with good practice and risk management related to the use of PICC (peripherally inserted central catheter). Using the same methodology, the working group elaborated these recommendations, which had become necessary as a result of the absence of any other reference documents on the subject, and the rapid dissemination of the technique, which has again become of current interest.

    Indeed, our predecessors used this technique more than thirty years ago, and then abandoned its application in adults. Only intensive care neonatologists, confronted with venous access problems in premature babies, have continued to use PICC. Progress in materials and insertion techniques have brought these devices back into favour with physicians. As in the case of any new means of healthcare, it became important to define their indications and conditions of use, to ensure the safety and benefits of this technique, by limiting the risks associated with its use. These devices are indeed central venous catheters, and some studies, French in particular, have been able

    to show that complications associated with their use were not so uncommon [1-3]. It thus became indispensable that the SF2H establish a pluridisciplinary working group, for the purposes of elaborating an appropriate set of recommendations. Based on the model used for the recommendations drawn up for totally implantable venous catheters (TIVC), the present recommendations have been drafted while taking into account the different steps of PICC use, including their indications and contraindications, the choice of materials, their insertion, utilisation, and maintenance. As in the case of TIVC, these devices can b