PICC Line Insertion

Overview

A peripherally inserted central catheter (PICC), also called a PICC line, is a long, thin tube that's inserted through a vein in your arm and passed through to the larger veins near your heart. Very rarely, the PICC line may be placed in your leg.

A PICC line gives your doctor access to the large central veins near the heart. It's generally used to give medications or liquid nutrition. A PICC line can help avoid the pain of frequent needle sticks and reduce the risk of irritation to the smaller veins in your arms.

A PICC line requires careful care and monitoring for complications, including infection and blood clots. If you're considering a PICC line, discuss the benefits and risks with your doctor.

A PICC line is one type of catheter used to access the large veins in your chest (central venous catheter). Examples of other types of central venous catheters include implantable ports and central lines.

Why it's done

A PICC line is used to deliver medications and other treatments directly to the large central veins near your heart.

Your doctor might recommend a PICC line if your treatment plan requires frequent needle sticks for medicine or blood draws. A PICC line is usually intended to be temporary and might be an option if your treatment is expected to last up to several weeks.

A PICC line is commonly recommended for:

·   Cancer treatments. Medicines that are infused through a vein, such as some chemotherapy and targeted therapy drugs, can be delivered through a PICC line.

·   Liquid nutrition (total parenteral nutrition). If your body can't process nutrients from food because of digestive system problems, you may need a PICC line for receiving liquid nutrition.

·   Infection treatments. Antibiotics and antifungal medicines can be given through a PICC line for serious infections.

·   Other medications. Some medicines can irritate the small veins, and giving these treatments through the PICC line reduces that risk. The larger veins in your chest carry more blood, so the medicines are diluted much faster, reducing the risk of injury to the veins.

Once your PICC line is in place, it can be used for other things, too, such as blood draws, blood transfusions and receiving contrast material before an imaging test.

Risks

PICC line complications can include:

·   Bleeding

·   Nerve injury

·   Irregular heartbeat

·   Damage to veins in your arm

·   Blood clots

·   Infection

·   A blocked or broken PICC line

Some complications can be treated so that your PICC line can remain in place. Other complications might require removing the PICC line. Depending on your situation, your doctor might recommend placing another PICC line or using a different type of central venous catheter.

Contact your doctor right away if you notice any signs or symptoms of PICC line complications, such as if:

·   The area around your PICC line is increasingly red, swollen, bruised or warm to the touch

·   You develop a fever or shortness of breath

·   The length of the catheter that sticks out of your arm gets longer

·   You have difficulty flushing your PICC line because it seems to be blocked

·   You notice changes in your heartbeat

How you prepare

To prepare for your PICC line insertion, you might have:

·   Blood tests. Your doctor may need to test your blood to make sure you have enough blood-clotting cells (platelets). If you don't have enough platelets, you may have an increased risk of bleeding. Medicine or a blood transfusion can increase the number of platelets in your blood.

·   Imaging tests. Your doctor might recommend imaging tests, such as an X-ray and ultrasound, to create pictures of your veins to plan the procedure.

·   A discussion of your other health conditions. Tell your doctor if you've had breast-removal surgery (mastectomy), as that may affect which arm is used for placing your PICC line. Also let your doctor know about previous arm injuries, serious burns or radiation treatment. A PICC line generally isn't recommended if there's a chance you may one day need dialysis for kidney failure, so let your doctor know if you have a history of kidney disease.

What you can expect

The procedure to insert the PICC line takes about an hour and can be done as an outpatient procedure, meaning it won't require a hospital stay. It's usually done in a procedure room that's equipped with imaging technology, such as X-ray machines, to help guide the procedure. PICC line insertion can be done by a nurse, doctor or other trained medical provider.

If you're staying in the hospital, the procedure might be done in your hospital room.

During PICC line insertion

During the PICC line insertion you'll lie down on your back with your arm extended to your side. You'll be awake during the procedure, but numbing medicine will be used to minimize discomfort.

A PICC line is usually inserted in a vein in your upper arm, above your elbow. Which arm is used depends on your particular situation, but usually the nondominant arm is used.

The doctor or nurse may use an ultrasound machine to assess the veins in your arm and make sure they're healthy enough to use for the PICC line. You might have a cuff tightened around your arm so that your veins stand out for inspection.

Once a suitable vein is identified in your arm, the skin around the area is cleaned and prepared. Numbing medicine is injected into the skin to minimize pain.

To place the PICC line, a needle is inserted through your skin and into the vein in your arm. Ultrasound or an X-ray might be used to confirm the placement. A small incision is made in the vein so that a thin, hollow tube (catheter) can be inserted.

Once the catheter is in your arm, it's carefully advanced along the vein. The catheter continues up your arm and toward your heart.

When the catheter reaches the right location, you might have an X-ray to verify the catheter is in place. If the procedure is being done in your hospital room, the doctor or nurse may use a heart-monitoring device to determine that the catheter has reached the correct location. You might have an X-ray later.

The other end of the catheter will stick out of your arm. A cap is placed over the end of the catheter to keep it free of germs. It may be taped down so it won't get in the way of your daily activities.

After PICC line insertion

After a PICC line insertion, there may be some tenderness in the area where the catheter enters your arm. It should go away within a few days.

As you adjust to life with a PICC line, you'll need to consider:

·   PICC line protection. Your doctor may recommend specific ways to protect the arm with the PICC line. For instance, don't lift heavy objects and don't have blood pressure readings taken on the affected arm. Your doctor might recommend avoiding jarring activities with your arm, such as throwing a ball. Avoid submerging the PICC line in water, such as might happen with swimming or using a hot tub.

·   PICC line care. A nurse or other provider will show you how to care for your PICC line. This might involve checking the area daily for signs of infection and flushing the line with solution weekly to keep it clear from clogs. It's easier if you have someone to help you with PICC line care. If you need help, you might consider hiring a home health care provider.

·   PICC line covers. You'll need to cover your PICC line when you take a shower, as the area shouldn't get wet. Your doctor or nurse might provide a cover or you can buy one at a drugstore. Other PICC line covers are available for daily use to protect the area or make it less obvious to other people.

Results

Your PICC line is kept in place for as long as you need it for treatment. 

PICC line removal

Your PICC line can be removed when your treatment ends. To remove the line, a doctor or nurse gently pulls on the end of the catheter to remove it from your arm.

PICC line removal reduces your risk of complications, such as infection. But if there's a chance you may need a PICC line again, your doctor may recommend keeping it in place. That's because repeatedly placing the PICC line increases the risk of damage to your veins.

References

AskMayoExpert. Central venous catheter. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.

SURGICAL INSTRUMENTS & O.R. NEEDS

INSTRUMENTS:

Excision set/Suturing set

OR NEEDS:

Disposable gowns/ Laparotomy pack

Sterile gloves

Lubricating jelly

Syringes (10cc, 1cc)

IV Cannula G20

Blade 11

Heparin (1000 IU/ml)

Lidocaine

Tegaderm (small and medium)

Operating sponge

Povidone Iodine (7.5%, 10%)

Sleeves/Stockinette

0.9% Sodium Chloride Solution

Alcohol

SUTURES:

Any atraumatic cutting needle available (Nylon or Silk)

DRESSING:

Operating sponge with Tegaderm

Biopatch (Optional)