In a few weeks, I will be undergoing my third home bronchial cleansing. All in all, I appreciate receiving my antibiotics intravenously at home. My only real problem is the frailty of my veins. Every three or four days I must go to the hospital to have a new short catheter (Jelco) inserted. For my next home treatment, my doctor suggests that I use a peripherally inserted catheter, or percutaneous catheter. Could you explain what a peripherally inserted catheter is, how it is inserted and whether there are any risks involved? Finally, do you think that the prolonged use of a peripherally inserted catheter would add to the deterioration of my veins?
A catheter is a tube that is inserted into a vein. The longer, peripherally inserted catheter is not very different from the commonly used short Jelco catheter. However, the difference in length is a major one. There are two kinds of long catheters: the MLC or midline catheter, and the PICC or peripherally inserted central catheter. The MLC measures up to 20 cm and its tip reaches from the point of insertion up to the shoulder. The PICC is longer and its tip extends to the superior vena cava, the central vein entering the heart.
The main advantage of these catheters is their durability. While a short catheter must be replaced every three or four days, the medium length MLC can last eight weeks, and the PICC can be used for as long as six months and sometimes longer. Insertion is not complicated but requires special training. In Quebec, doctors usually insert this type of catheter, whereas in the United States, specialized nurses are authorized to do the job. The basic principles are similar to those for inserting short catheters. However, they must be put in under much stricter sterile conditions; only the large veins in the arm (basilic or cephalic), above or below the elbow, can be used.
When a PICC is inserted, the position of the catheter must be verified by X-ray. Risks include bleeding, tendon or nerve damage, and cardiac arrhythmia (when the catheter enters the heart, it can cause a rhythm disturbance). Other problems include incorrect positioning of the catheter and breakage, causing a fragment to migrate to the heart or lungs. After insertion, there is also the risk of infection, or of superficial or deep phlebitis (inflammation of the vein). Most of these complications are quite rare, however; the most frequent complications are phlebitis (3 – 4%) and a blocked catheter.
With the long catheters described above, specific complications such as pneumothorax and hemothorax (air or blood in the pleura of the lung) are avoided. These problems are related to the insertion of subclavian catheters, which differ from the long catheters above. Furthermore, subclavian catheters cannot be used for more than two weeks.
Repeated use of a long catheter will surely prevent deterioration of the small superficial veins in the arm. There is a slight risk of damaging the large superficial veins as well as the deeper veins, but this is an acceptable calculated risk.