When the deep veins of the arm are available at ultrasound examination (at least on one side), the preferred CVC is the PICC. This access is in fact particularly free from risks of significant complications to the insertion, it can be implanted even in patients who are very fragile from the cardiorespiratory or coagulative point of view, and it benefits from an emergency site (at mid-arm) particularly favorable both for the low contamination bacterial both for its ease in maintaining a good coverage dressing.
The main contraindications to the placement of a PICC are:
- the presence of a chronic renal failure of grade 3b -4 - 5 (i.e., likely current or future need for chronic hemodialysis treatment with an A-V fistula)
- the (bilateral) presence of various types of pathologies of the upper limb, either vascular (previous or current venous thrombosis), or lymphatic (previous axillary lymphadenectomy), or neuromuscular (paresis or chronic plegia), or cutaneous (burns or other skin lesions , infectious or dystrophic), or osteoarticular (ankyloses, fractures, etc.).