PICCs in intensive care units: new Spanish guidelines fill a gap

When and how should peripherally inserted central catheters (PICCs) be used in intensive care units (ICUs)? At the end of 2022, the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) published: 

Guía de práctica clínica sobre el uso de catéteres venosos centrales de inserción periférica (PICC) en el paciente crítico (Clinical practice guidelines on the use of peripherally inserted central catheters (PICCs) in critically ill patients)¹ 

BD IV News interviewed Noemí Cortés Rey, a member of the working group that created these practice guidelines. Ms. Cortés Rey is a nurse training supervisor at University Hospital of A Coruña in Spain. 

She used to work in the ICU and understands the challenges healthcare professionals (HCPs) face when selecting and maintaining vascular access devices (VADs) in these settings. With her colleagues, she implemented a vascular access team (VAT) in the ICU. 

More on this topic: The push to build vascular access teams in Ireland 

1. What was the situation in Spanish intensive care units before 2022?

Ms Cortés Rey said that before the guidelines were developed, Spanish nurses usually followed the U.S. Infusion Therapy Standards of Practice from the Infusion Nurses Society. But she added that these didn’t completely cover vascular access management (VAM) in critical care. 

2. Why were these intensive care unit practice guidelines created?

Ms Cortés Rey explained that SEMICYUC launched a project to come up with evidence-based guidelines for PICCs in ICUs. The use of PICCs has increased exponentially over the last few years on general wards and especially in ICUs.² However, PICCs have multiple indications, but it was not very clear how to apply them in critical care patients according to Ms Cortés Rey. 

She said the aim of SEMICYUC was to create a useful tool to clarify these indications, help Spanish ICU HCPs in VAM, prevent IV complications and reduce adverse events. 

3. What advantages do PICCs in intensive care units have over other acute central venous catheters?

She pointed out the main advantage of PICCs: They’re useful for patients requiring medium- to long-term IV therapy. She added they can be inserted by trained doctors and nurses (mainly by the latter). 

Because nurses work at the patients’ bedside 24/7, PICCs can be usCashed whenever they’re needed explained Ms Cortés Rey. She thinks this type of VAD can be useful for certain patient populations, including patients with obesity, thoracic trauma, stoma or coagulation disorders. 

She doesn’t recommend using PICCs in emergency situations as the first option when a central line is needed. In this case, centrally inserted central catheters (CICCs) are the first choice due to the need for immediate insertion according to her.  

4. How have these practice guidelines been received by critical care nurses and doctors? 

When Ms Cortés Rey started to review the medical literature, she couldn’t find many research papers focusing on the use of PICCs in critical care. Thanks to these new guidelines, nurses and doctors from ICUs are quickly gaining new knowledge and expertise.  

5. What has been the impact of these practice guidelines on patient care?

She felt like she and her colleagues had reached an inflection point when they started implementing a VAT and using PICCs in critical care.  

She expanded on this by adding that some of their patients, like those undergoing lung or liver transplant stay in the ICU for a long time. They may need 3–5 central lines at the same time. These patients usually start with a CICC (in the jugular vein). Within 10–14 days, nurses insert a PICC and remove the CICC. Some patients keep both. 

Using these guidelines when implementing PICCs in critical care allows HCPs to standardise practice through updated protocols that help reduce variability.² By following these new guidelines, Ms Cortés Rey shared that HCPs in her ICU have dramatically reduced rates of thrombosis and catheter-related bloodstream infections (CRBSIs) in their patients. 

More on this topic: How to identify and reduce the risk of catheter-related thrombosis 

The SEMICYUC concludes, “We are very satisfied with the work done and hope that these guidelines will enable coordinated, safe and efficient decision making on the use of PICCs by professionals and improve the quality of care, while increasing patient and professional satisfaction.”² 

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