• Peripherally Inserted Central Catheter

    (PICC)

    Definition

    A peripherally inserted central catheter is a long, thin tube that is inserted through a vein in the arm. The catheter is threaded through the arm vein until it reaches a larger vein close to the heart. This is commonly called a PICC line.
    Veins in the Arm
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    PICC lines may be used if you need:
    • Long-term medicine treatment and cannot take medicine by mouth
    • Fluids—if you cannot drink enough to stay hydrated
    • Chemotherapy
    • Calories that you cannot get by eating
    • Intravenous (IV) medicine—if arm veins are hard to find or use
    Once the PICC line is in, it can be used for weeks to months.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a PICC line, your doctor will review a list of possible complications which may include:
    • Bloodstream infection —occurs when bacteria enters the bloodstream through or around the central line
    • Bleeding
    • Heart arrhythmias (abnormal heart beat)—can occur if the catheter tip is out of place and too close to the heart
    • Nerve injury (tingling or pain in the arm where catheter is inserted)
    • Blood clots
    • Air or catheter embolus (air bubble or part of catheter blocks a blood vessel)
    Factors that may increase the risk of complications include:
    • Smoking
    • Arm veins that are hard to find (due to obesity or poor blood flow)
    • Blood clots
    • Broken arm
    • Active infection
    • Lymph nodes removed from the arm
    Discuss these risks with your doctor before your PICC line is inserted.

    What to Expect

    Prior to Procedure

    • You may have your blood drawn to check how well your blood clots.
    • Your doctor may ask you questions like whether you have any allergies and which arm is dominant.
    • Arrange for a ride home after the procedure, as your arm may be numb.
    • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure. Medicines stopped may include:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, like warfarin (Coumadin)
      • Clopidogrel (Plavix)

    Anesthesia

    You will be given a local anesthetic to numb the area where the PICC line will be inserted.

    Description of Procedure

    This procedure is usually done in an outpatient setting, so you will not need to stay overnight in the hospital. If you are already in the hospital for a different reason, this procedure is not likely to extend your stay.
    Having a catheter inserted increases your risk of a bloodstream infection. The hospital staff will begin the procedure by taking the following steps to reduce this risk:
    • Carefully choose a safe site to insert the catheter.
    • Thoroughly wash their hands or use a hand sanitizer.
    • Wear surgical gowns, masks, gloves, and hair coverings.
    • Clean your arm with antiseptic cleanser.
    • Place a sterile sheet over you.
    Next, the staff will:
    • Give you an anesthetic.
    • Extend your arm away from your body.
    • Measure the distance from your arm vein to where the catheter will end.
    • Cut the catheter to the correct length. Flush the catheter with saline (salt water).
    • Place a tourniquet on your arm. A tourniquet is a device used to slow blood flow.
    • Make a small incision.
    • Insert the catheter into your vein. An ultrasound may be used to help place the catheter.
    • Use sutures or tape to secure the PICC line. Place caps on the end of the catheter.
    • Cover the insertion site with a bandage. Write the date of the insertion on or near the bandage.

    Immediately After Procedure

    Your arm will be checked for bleeding, drainage, and bruising.

    How Long Will It Take?

    About half an hour

    How Much Will It Hurt?

    During the procedure, you will not feel any pain because of the anesthetic. There may be mild discomfort at the insertion site after the procedure.

    Post-procedure Care

    At the Care Center
    Following the procedure, the staff may provide the following care to help you recover:
    • Do an x-ray to make sure your catheter is in the correct position.
    • Continue to check the insertion site for bleeding.
    • Give you medicines, fluids, or nutrition through the catheter.
    • Flush catheter ports to prevent blood clots.
    • Take steps to reduce your risk of infection by:
      • Thoroughly washing their hands and wearing gloves before touching the catheter or changing the bandage
      • Using an antiseptic to clean the catheter opening
      • Taking precautions when handling medicine, fluid, or nutrition that will be delivered through the catheter
      • Watching you closely for signs of infections—These signs include fever, chills, and problems at the insertion site (eg, redness, swelling, drainage).
      • Not allowing visitors in your hospital room when the bandage is being changed
      • Keeping the catheter in place only as long as it is needed
    There are also steps that you can take to reduce your risk of infection:
    • Ask the staff to take every precaution to prevent an infection.
    • Tell the staff right away if the bandage needs to be changed or if the site is red or sore.
    • Ask everyone entering your hospital room to wash their hands. Do not allow visitors to touch your catheter.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Keep your insertion site clean, dry, and covered with a bandage. Follow your doctor's instructions for changing the bandage.
    • Before touching the catheter, wash your hands or use a hand sanitizer. Wear gloves when touching the area.
    • If allowed by your doctor, cover the bandage with plastic when showering.
    • Do not swim or bathe while your PICC line is in.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Avoid lifting or any kind of activity that may loosen the PICC line.
    • Do not allow anyone to touch the catheter or the tube.
    • Check the insertion site daily for signs of infection (eg, redness or pain).
    • Learn how to take care of your catheter .
    • Flush the line with saline or heparin as directed.
    • Take medicine as directed.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • Signs of infection—fever, chills, redness or swelling at the insertion site
    • Pain around the insertion site
    • Drainage or leakage from the PICC line
    • Trouble flushing or inserting fluids into the PICC line
    • PICC line falls out or becomes loose
    • Arm grows larger in circumference
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Cancer Society http://cancer.org/

    Vascular Access Management http://picclinenursing.com/

    CANADIAN RESOURCES

    The College of Family Physicians of Canada http://www.cfpc.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Caring for your peripherally inserted central catheter. Cystic Fibrosis website. Available at: http://www.cff.org/UploadedFiles/treatments/Therapies/Respiratory/PICC/PICC%20Fact%20Sheet.pdf/ . Accessed September 14, 2009.

    Central venous catheter. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 1, 2009. Accessed September 14, 2009.

    FAQs: Catheter-associated bloodstream infections. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/BSI%5Flargertext.pdf . Accessed January 12, 2010.

    Neff D. Preventing infections during surgery: what hospital staff and patients can do. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated January 2010. Accessed January 12, 2010.

    Walsh K. Peripherally inserted central catheter (PICC) care: an overview. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Published August 28, 2009. Accessed September 14, 2009.

    Walsh K. Peripherally inserted central catheter (PICC) care: insertion techniques. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Published August 28, 2009. Accessed September 14, 2009.

    What is a PICC line and why do I need it? Vascular Access Management website. Available at: http://picclinenursing.com/picc%5Fwhy.html . Accessed September 14, 2009.

    6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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