PICC- Peripherally Inserted Central Catheter

PICC- Peripherally Inserted Central Catheter Facility: (Affix identification label here) URN: Family name: Given name(s): Address: Date of birth: Sex: M F I Page 1 of 2 Continues over page - 03/2011 The State of Queensland (Queensland Health), 2011 Permission to reproduce should be sought from DO NOT WRITE IN THIS BINDING MARGIN A. Interpreter / cultural needs An Interpreter Service is required? Yes No If Yes, is a qualified Interpreter present? Yes No A Cultural Support Person is required? Yes No If Yes, is a Cultural Support Person present? Yes No B. Procedure The following will be performed (Doctor/doctor delegate to document include site and/or side where relevant to the procedure) .. Peripherally Inserted Central Catheter (PICC) is a long, narrow tube ( Catheter ) about the same size as a strand of long spaghetti. It is used to give you medication directly into your blood stream without having to repeatedly insert a needle into your vein.

Peripherally Inserted Central Catheter (PICC) is a long, narrow tube (catheter) about the same size as a strand of long spaghetti. It is used to give you medication directly into your blood stream without having to repeatedly insert a needle into your vein. Using ultrasound as a guide the needle will be inserted into your vein.

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