The Groshong peripheral inserted central (PIC) catheter: Initial experience with ultrasound-guided insertion

We report our initial experience on the peripherally inserted central (PIC) catheters inserted under ultrasound guide to serve as alternative venous access devices for I.V. fluid and chemotherapy in a series of hematology/oncology patients who had difficult venous access by other means. Ten peripherally inserted central (PIC) catheters with a Groshong tip were inserted successfully in 8 oncology and 2 hematology patients (mean age 59.7 years, range 37 to 73 years) for mid to long-term venous access. These patients were unable to undergo implanted subcutaneous port placement because of disease status and had no visible peripheral vein for venous access by ordinary means. Catheters were inserted under image guidance (ultrasound and fluoroscopy) via the brachial vein or basilic vein in the nondominant forearm. Catheter tips were placed at the junction of the superior vena cava and right atrium. The externalized portion of the catheter was capped and sutured onto patient's skin at the forearm, and fixed like an ordinary intravenous line. PIC catheter insertion was successful in 100% of cases. One patient had a missed puncture which pierced the brachial artery. No immediate complication such as hematoma or nerve injury was noted. No phlebitis, venous thrombosis or infection was noted during this short-term follow up. These 4- French single lumen catheters were used for infusion of chemotherapeutic agents, fluid replacement, injection of antibiotics, and blood withdrawal as well as for total parenteral nutrition. The longest indwelling time was 58 days (average 34.8 days). Routine maintenance was done with 10 c.c. of non- heparinized saline. Patient, nurse and physician acceptance of the PIC catheter was good especially for this group of patients with difficult venous access. PIC catheter insertion by an interventional radiologist has a high technical success rate and is safe. If the estimated use time of a venous access device is more than 1 week and less than 6 months, a PIC catheter is recommended. For venous access, they serve as an alternative to tunneled catheters, non-tunneled catheters and implanted subcutaneous ports because of ease of insertion, maintenance, and removal and low reported infection rate.