Background Although Peripherally Inserted Central Catheters (PICCs) minimise procedure related pain and allow effective absorption of parenteral fluids and medications for patients when the oral route is no longer feasible, there is limited empirical data regarding their efficacy, safety and patient satisfaction in palliative care. A systematic literature review was undertaken on the role of PICCs in palliative care utilising GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria. The level of evidence was MODERATE. This emerging literature suggests minimal pain and distress on insertion, limited complications and a favourable impact on quality of life.
Our patients Over a 12 month period, 24 patients underwent PICC insertion, 83% were women, 92% had solid tumours and the average age was 70 (range 36–94). 899 PICC days were monitored, the average number of days of placement was 37 (range 1–250). The indications for PICCs were hydration (92%), medication administration (92%) and blood sampling (88%). PICCS were inserted for all three indications in 19 (79%) patients. Three PICCs required replacement and one required removal. Only one of these was in relation to infection. This was an unconfirmed line infection and was on the advice of microbiology. The limited complications identified are likely due to all procedures being performed by the nurse-led Vascular Access Team, under aseptic conditions, utilising ultrasound and intracavitary ECG guidance and meticulous aftercare.
The benefits PICCs are synergistic with the philosophy of palliative care. A philosophy, which supports all symptoms to be managed, prevents new symptoms from arising and promotes opportunities for meaningful and valuable experiences. Administration of IV medication and blood products has facilitated the treatment of anaemia, infection, hypercalcaemia, refeeding syndrome and raised intracranial pressure whilst identification of anomalies in blood results supports clinical decision-making. Feedback from patients, families and staff has been overwhelmingly positive. In the words of the patient with the longest placement, a PICC is ‘convenient and clean’.
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