PICC Lines: What You Should Know

A Peripherally Inserted Central Catheter, or "PICC line," is a thin, soft plastic tube—like an intravenous (IV) line—that allows you to receive medicines and fluids. A PICC line stays in place for as long as needed.

A nurse places a PICC line into a large vein in your arm and guides the catheter up into the main vein near your heart where blood flows quickly. The nurse sutures (stitches) the PICC line in place and covers the site with a sterile bandage. An x-ray is done to make sure that the catheter is in the right place. It takes 1 – 1.5 hours to place the PICC line. Most patients feel little or no discomfort during this procedure. A local anesthetic may be used.

Before Your PICC Line Insertion

• Usually, the nurse inserts your PICC line in the hospital room. Sometimes, a Radiologist may insert the PICC line.
• You sign a consent form stating that you understand the procedure.
• The medical and nursing staff reviews the risks and benefits of this procedure with you. This is a good time to ask any questions you have.

Understanding the Risks and Benefits of PICC Line Insertion

Risks During Insertion

• There may be slight discomfort when the introducer needle is put into your vein.
• If your veins have scars or are partly clotted from many IVs, this type of IV catheter may not be a good option for you.
• Sometimes, the nurse or doctor cannot use the vein in one arm and may place the line in the other arm.
• Puncture of a blood vessel, nerve or tendon near the insertion site is possible.
• You may have an irregular heartbeat because the catheter was put too far into the heart.

Risks After the Insertion

• The catheter can move out of position in the vein if you cough or move a lot or have severe vomiting. The catheter may need to be removed or repositioned.
• The PICC line can move out of position if it is not secured in place (with sutures).
• There is a risk of vein clotting (thrombosis) or vein inflammation (phlebitis).
• You may get an infection at the insertion site or in your bloodstream. The catheter may need to be removed and you may need antibiotics.
• The PICC line can get blocked with a clot. This can usually be cleared.
• A piece of catheter may break off and travel into the bloodstream.

Benefits

• A PICC line can be cared for at home and can stay in place for many weeks, or months, if needed.
• The risk of infection is low.
• You can get fluids to hydrate you and give you nutrition, blood transfusions and medicines, like chemotherapy or antibiotics.
• A PICC line can be used to get blood tests, without another needle stick.
• There is a smaller chance of irritation and damage to your veins and blood vessels that can result from many blood draws, IV insertions and IV medicines.

Options

• You can have a regular IV placed in a vein in your arm or hand. This requires changing every 3 days.
• A doctor can place a central line into a vein in your neck, upper chest or groin area. This type of catheter is for short-term use (less than two weeks) and requires you stay in the hospital.
• There are other types of catheters that are placed under your skin for long-term use. You may need to go to the operating room for these to be placed.

How Is the PICC Line Inserted?

1. A nurse may use an ultrasound machine to find the veins in your upper arm.
2. The nurse cleans your arm and covers it with a sterile cloth to prevent infection.
3. The nurse places a tourniquet on your arm.
4. You get a numbing medicine.
5. The nurse puts a small needle into the vein, inserts the introducer needle and guides the PICC line into the vein near your heart.
6. You have a chest x-ray afterwards to make sure that the PICC line is in the right place.
7. After numbing the skin, the nurse places sutures to hold the PICC line in place.
8. The nurse covers the insertion site with a clear, sterile dressing and a pressure bandage. The dressing is changed after 24 hours or twice a week.

Your Care at Home After PICC Line Insertion

• DO NOT take a bath in a bathtub. Cover the insertion site with clear, plastic wrap and tape to keep it dry before showering.
• No swimming. No hot tubs.
• Avoid a lot of arm movement and coughing. Avoid lifting weight. Check with your doctor about activity limitations with your PICC line.
• Your arm may be tender and a little uncomfortable for one to two days. Rest your arm for one day after the insertion.
• It is normal to see a small amount of blood leaking from the insertion site the day after the procedure. There may also be some bruising.
• When you are home, your PICC line is cared for by a nurse from a home care agency, your doctor's office or an infusion center. You can also learn to take care of the line yourself.

Call Your Healthcare Provider Immediately If You Have:

• Pain
• Fever
• A large amount of bright red bleeding (soaking the dressing with blood).
• Warmth, redness or swelling along the arm or PICC line insertion site.
• A tear or break in the PICC line catheter or tubing.
• The IV pump continues to alarm, even after flushing the catheter.
• Any leakage of IV fluid from around the PICC line insertion site.