Peripherally inserted central catheter
A peripherally inserted central catheter (PICC), or PICC line, is a catheter that is placed in the antecubital vein (a large vein in the inner elbow area). It is threaded through the vein into or near the right atrium of the heart.
A PICC can be inserted by an IV nurse, rather than a surgeon. It can stay in place for many weeks or months, which avoids the need for a new IV every few days. PICCs can be used to deliver chemotherapy, antibiotics, blood products, other medicines and intravenous nutrition.
To access the PICC, an IV line is connected to the end of the catheter. When the PICC is not in use, the IV is disconnected and the catheter is flushed and capped.
When a PICC is used
A peripherally inserted central catheter is used when:
- a person needs intravenous (IV) access to receive fluids or drugs over a long period of time
- the small veins in the body can no longer be used for giving fluids or drugs
Benefits of a PICC
There are many benefits to having a PICC rather than a regular IV. The most important benefit is that it reduces the number of needle sticks. However, it is important not to tell children that having a PICC means they will never have to be “poked” again, since they may still need needle sticks for some blood tests.
- can stay in the arm from 1 week to 3 months
- causes less discomfort because IV therapy can be given more easily
- prevents the “burning” sensation sometimes felt when getting drugs by other IV methods
How a PICC is placed
A nurse or doctor places a PICC in a procedure room. Generally, adults and older children will be awake for the procedure. Small children may be sedated if necessary.
- The person lies on a flat surface.
- The arm must be kept straight and still during the procedure.
- A local anesthetic cream is applied to numb the area.
- An injection to numb the area is given to decrease discomfort during insertion.
- A special needle is used to place the PICC into the arm vein.
- The catheter is then threaded through the needle.
- A dressing is placed over the insertion site.
- Once the line is in place, a chest x-ray is taken to make sure it is in the right position.
How a PICC works
When the person needs IV therapy, the IV tubing is connected to the end of the catheter outside the body. The fluid or medicine flows through the IV tubing into the catheter, then into the bloodstream. After treatment is over, the IV tubing is removed and a new cap is placed on the end of the catheter.
Possible complications of a PICC include:
- irritated vein
- The vein where the catheter is placed may become irritated.
- infection in the skin at the exit site or in the blood
- Some infections can be treated with antibiotics without removing the PICC.
- Sometimes it must be removed.
- torn catheter
- A hole or tear in the line can occur.
- The PICC must be removed.
- the PICC moves and irritates to the vein
- The PICC may be removed.
While a PICC is in use
While the person receives an IV solution through the PICC:
- The end of the catheter is attached to plastic tubing that runs through a small machine (IV pump), which pumps the solution into the vein.
- Adults do not need to stay in bed. A child may be held or can get out of bed.
- The part of the catheter outside the body will be coiled on top of the dressing and covered with tape to prevent any pulling or strain on the catheter.
- Be careful that the IV tubing does not get pulled.
- Let the nurse know immediately if any part of the catheter comes out or if the tubing becomes disconnected.
Caring for a PICC
The PICC needs care to prevent problems. The person will be taught how to:
- change the dressing on a weekly basis or if it gets wet or is exposed to the air
- flush the line after use or every day
- change the injection cap
- check the site for signs of infection
Removing a PICC
The PICC will be removed when IV therapy is no longer needed. A local anesthetic is used to numb the area at the catheter exit site.
When to call the doctor
Call the doctor if:
- there is any redness, tenderness, swelling, tingling or drainage at or near the catheter exit site
- the person has a fever, aches or flu-like symptoms
- the catheter moves
- you cannot flush the catheter with heparin
- the catheter breaks