Peripherally Inserted Central Catheter Line

What is a PICC line?

A PICC line is a long, thin plastic tube that is inserted in a vein near or above the bend of your arm. The tip of this thin tube is intended to reach the large vein above your heart (the Superior Vena Cava) to administer long-term medications or fluids directly in the vein. These medications can be for a treatment, such as antibiotics for an infection, or for nutritional supplementation, such as the administration of total parental nutrition.

A PICC line can also be used for blood withdrawals.

A PICC line is an effective solution for extended IV therapy, with benefits like long-term use and lower infection risk, but it does come with some associated risks. Always consult your healthcare team for specific care instructions and for any concerns.

Insertion and maintenance procedure

Insertion

The below steps can be done by a specialized nurse or a physician:

• You will be educated on the indication for the PICC line, where will it be inserted, how long is it planned to stay, what are the steps needed to maintain the PICC line at home, and how often to follow up with a healthcare facility.
• After your concerns and queries have been addressed, you will be escorted to a sterile environment for PICC line insertion.
• The insertion can be at bedside or in the Interventional radiology department. It will be under the guidance of an ultrasound device.
• Local anesthesia will be used to numb the area, ensuring you’re comfortable and pain free.

Post-insertion care

• After placement, a chest Xray might be ordered to confirm the correct placement of the PICC line.
• With proper care, your PICC line can last from several weeks to months, with the average duration being 28 days.
• PICC line care, such as dressing change and administering flushes or medication can only be done by a healthcare professional.
• Flushing is important for the maintenance of a PICC line as it prevent clots and infection.
• Timely-dressing change is also integral to prevent Catheter Line Associated Infections, or CLABSIs.

PICC line Benefits

• Long-lasting: Can be used in various settings (home, hospital).
• Versatile: Suitable for fluids, medications (like chemotherapy), and some blood draws.
• Reduced infection risk compared to other intravenous methods.

What can I do to maintain my line?

1. During Hospitalization

• The line needs to be clean and dry at all times. Inform your nurse when you need to take a shower for the necessary precautions to be applied to protect the line, such as applying a shower protector.
• Do not manipulate the line. If the dressing is bothering you or your notice a leak or dislodgment, please inform your nurse.
• Medications will only be administered by your nurse. Please do not attempt to do so yourself.
• Be careful not to accidentally pull on your catheter or for the catheter to be tugged to your clothing. Please ask the nurse to support with securing your catheter as you mobilize and before you sleep. If you notice any dislodgment of the dressing or experience accidental pulling, please inform the nurse immediately.

2. General Dos and Don’ts

• Avoid pushing, pulling, or lifting of heavy objects (more than 3-5 kilos).
• You are encouraged to move your arm as you normally do, but avoid extreme repetitive use of the arm and heavy lifting
• Never have scissors or sharp objects near your PICC line
• Never pull on the PICC line or the tubing connected to it
• Inform your healthcare provider of your PICC line – avoid needle pricks close to the site and do not use your arm for blood pressure monitoring.
• You are allowed to shower as long as the PICC line is covered to protect it from getting wet. It can be covered with a clear plastic bag and tape, ensuring a propel seal, and it needs to be dried gently by tapping immediately after a shower. Soaking in water is not allowed, such as swimming in pools or sitting in a bathtub with your arm under the water level.

3. Going home with a PICC Line

• PICC line care and maintenance can only be done by a health care professional. Please discuss the discharge plan with your physician. The care and maintenance can be done at home by a qualified home care nurse or at a healthcare facility.
• Do not inject anything into the line.
• Always secure the line when moving.
• Do not manipulate the site yourself or any member of your family.
• Make sure you wear loose clothes on your upper body.
• If you feel pain or discomfort during medication administration, please notify your physician or administering healthcare professional.
• Make sure you come to your follow up appointments as scheduled and you with the treatment plan not to affect the integrity of the line or the success of the treatment. The removal of a PICC line will be in a hospital setting – please make sure you discuss the plan and duration of the PICC line with your physician.

Let your healthcare provider know if:

• The PICC line is difficult to flush, the medication is taking longer than usual to infuse, or your pump alarms because of an obstruction.
• There is redness, pain or drainage where the PICC line comes out f your arm.
• You experience pain or discomfort when fluids/medications are put into your PICC line,
• Your PICC line moved IN or OUT its place in your arm (Do not try to put it back in).
• There is a leak, break or damage to the PICC line (fold and tape the PICC line between the break/leak and where the catheter comes out your arm).
• You have pain or swelling of your arm, or redness along the path of the vein.
• You have signs of infection, such as fever or chills, swelling, oozing or redness around the site.
• You have signs of bleeding, such as bleeding or drainage where the PICC line comes out of your arm.
• You have missed doses of medications because the PICC line did not work.
• You have signs of a clot, such as swelling, redness pain in the arm, chest pain.