The “off-label” use of PICCs

Abstract

PICCs are versatile venous access devices which have potentialities far beyond their conventional use as central catheters inserted via a vein of the upper arm. They can be inserted in almost any vein which may be punctured and cannulated by ultrasound guidance, both in children and in adults, still remaining a central venous access in most cases. Their “off-label” use as CVCs has many advantages, considering that standard CVCs are technologically inferior to PICCs in terms of biocompatibility, technique of insertion, versatility, and accessories for placement and securement. In many cases, also the technique of PICC insertion may be enhanced, by including the maneuver of tunnelization, which allows to optimize simultaneously the puncture site and the exit site. Finally, though PICCs are commonly labelled for intravenous therapy, blood sampling, and hemodynamic monitoring, new interesting clinical tests suggest that they may have a future role in blood-exchange procedures such as apheresis, dialysis, and ultrafiltration.