What Is a PICC Line? | by heidi

What Is a PICC Line? | by heidi


     


    A peripherally inserted central catheter, also known as a PICC line, is a long, flexible tube (catheter) that is inserted into a vein in your upper arm. After insertion, the catheter is threaded to a central vein near the heart. The PICC line can be used to deliver fluids and medications, draw blood, or perform blood transfusions.1



    Having a PICC line reduces the need for repeated needle sticks. The line can stay in your body for up to 18 months. Your doctor can then remove it when you do not need it anymore.


    A PICC line can also deliver larger volumes of fluids and medications that might otherwise be too irritating to tissues if delivered through a standard intravenous (IV) line.2


    Home healthcare nurse tending to picc line of recovering patient

    This article explains when is PICC line is used and the process by which it is inserted and removed. It also outlines the possible risks of a PICC line and what you can do to reduce the risk.


    Uses of a PICC Line

    A PICC line can be used when a person needs intravenous treatment of any sort for a prolonged period. This includes:


    Antibiotics or antifungals: Systemic (whole-body) bacterial or fungal infections can sometimes require daily IV drugs for weeks at a time.

    Cancer treatment: Intravenous chemotherapy drugs can be caustic to tissues. Rather than delivering them to smaller veins in the arm, the doctor can use a PICC line to deliver them to larger veins where they do less harm.1

    Liquid nutrition: Liquid nutrition, also known as total parenteral nutrition, can be given daily through a PICC line for people who are unable to eat or absorb nutrition.

    Heart medications: Intravenous medications can also be given continuously to people with severe congestive heart failure.

    The PICC line has multiple ports outside of the body, called lumens. These allow medications to be given at the same time without mixing. Blood transfusions can also be performed simultaneously.



    PICC lines can also be useful when blood needs to be drawn repeatedly or on an ongoing basis.



    Recap

    A PICC line is used to deliver medications, fluids, liquid nutrition, or blood on an ongoing basis without the need for repeated needle sticks. A PICC line has multiple ports, called lumens, through which IV treatments can be given simultaneously.


     How Central Venous Catheters Are Used


    PICC Line Procedure

    The PICC line is a catheter with a guidewire inside. This stiffens the tube so that it is easier to thread into a vein.



    PICC lines are usually placed by a nurse or physician assistant at the bedside of a person in a hospital or care facility. It can also be done on an outpatient basis in advance of chemotherapy treatments.


    The procedure takes about an hour and typically involves the following steps:3



    A vein is selected. A non-invasive imaging tool called an ultrasound may be used to select the best site and guide the placement of the line.

    The insertion site is injected with a numbing agent (typically 1% lidocaine solution).

    After the site is cleaned, a small incision is made to access the vein.

    The line is gently threaded into the vessel and advanced toward (but not into) the heart. You may feel an unusual pressure but generally no pain.

    Once the line is placed, it is secured to the skin of the arm with stitches.

    An X-ray is performed to ensure the line is correctly positioned.

    Removal

    The removal of a PICC line is quick and typically painless. The stitches holding the line are removed, after which the line is gently pulled from the arm. Most people say that it feels strange to have the line removed, but it is neither uncomfortable nor painful.


    Once the PICC line is out, the end of the line is inspected. It should look the same as it did when it was inserted, with no missing pieces that could be left inside the body.


    A sterile bandage is placed over the wound and left for two or three days while the wound heals.


    Recap

    A PICC line can be placed on an inpatient or outpatient basis by a nurse or physician's assistant. The procedure takes about an hour and uses a numbing agent to avoid pain. The removal of the line is also usually painless.


     When a Central Line Is Necessary

    Risks and Complications

    PICC lines carry certain risks, some of which are manageable and others of which may be life-threatening. Possible complications include:4

    Malfunction: PICC lines can become clogged by substances delivered through the line. There are medications that can help break up the blockage, but the line will sometimes need to be replaced.

    Infection: A bacterial infection can develop if the ports or insertion sites are not routinely cleaned and cared for. The risk increases the longer the PICC line remains in place.

    Blood clots: A blood clot can develop at the inner end of the line. If the clot breaks free, it can travel through the heart to a lung, causing a potentially life-threatening obstruction known as a pulmonary embolism. 

    Cardiac arrhythmia: If the line is placed too close to the heart (or in the heart), it can trigger abnormal heartbeats known as cardiac arrhythmia. If not treated immediately, the line can end up damaging the heart muscle or valves.

    Recap

    There are risks associated with the placement of a PICC line, including infection, blood clots, and abnormal heart rhythms. The line can also get clogged and may sometimes need to be replaced.


    Safety Tips

    PICC lines require regular maintenance to avoid infection. In addition to routine dressing changes, the ports need to be regularly cleaned and flushed with sterile fluid. It is also important to wash your hands before touching the ports or any part of the PICC line.5


    Your healthcare provider will let you know which activities you will need to avoid, such as heavy lifting or contact sports.


    You will also need to cover the PICC sites with plastic wrap or a waterproof bandage whenever showering. You should never get the PICC site wet, so submerging your arm in a bathtub or pool must be avoided until the line is removed and the wound is healed.


    Seek urgent care if you experience any of the following with a PICC line:


    The port won’t flush.

    The PICC line leaks.

    The portion of the line outside the body is suddenly longer.

    You develop sudden arm or chest pain.

    There is increasing pain, warmth, redness, or swelling around the insertion site.

    You develop a high fever with chills.

    You notice changes in your heartbeat, such as palpitations.


    Recap

    A PICC line needs to be properly maintained to avoid infection. This includes changing the dressings regularly, cleaning and flushing the ports, and washing your hands before touching the ports or any part of the PICC line.

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