1) What is a PICC line?

PICC is also known as Peripherally inserted central catheter, it is also known as PICC line, it is a thin tube that is inserted into the vein of the arm or the larger veins present near the heart. It can also be placed in the veins of the leg.

2) What is the usage of the PICC line?

The indications of the PICC line are- delivery of nutrition ( parental when the oral mode of feeding is not possible in patients ), delivery of antibiotics, and other pain killers, also in patients with chemotherapy or repeated blood transfusions.

3) What are the different types of IV lines?

The different types of IV lines are- Peripheral IV line ( PIV )- this is short and placed at the forearm Peripherally inserted central catheter ( PICC ) line- this is long and placed in the upper arm Central venous catheter ( CVC )- this is long and is placed on the chest or neck Portacath- this is short and placed under the skin of the chest

4) How long can the PICC line be placed?

The PICC line can stay in the body or veins for as long as 18 months ( the entire duration of the treatment ). The doctor will remove it if it is not needed any further. PICC line allows the person to do their daily normal activities like- work, school, bathing, mild exercise. The site of insertion must be kept clean.

5) Which is better : PICC line or IV line?

The PICC line is thicker than IV line and is more durable. PICC is longer and can be inserted farther into the veins. Also it can stay upto 3 months or more, compared to normal IV line.

6) Is placing the PICC line painful?

Mostly, placing the PICC line is not painful, as it is inserted into the vein in the arm, to reach the area that is very close to the heart.

7) Can patients go home and resume work after the PICC line is placed?

Yes, the patient can go home and carefully resume their daily activities after the PICC line is placed. Patients must take proper precautions to prevent any infections at the site of insertion, must wash the site carefully as the chances of germs spreading is high.

8) What is the cost of PICC line insertion in India?

The cost of PICC line insertion in India varies across different cities and hospitals- Cost of PICC line insertion in India CITY COST Cost of PICC line insertion in Mumbai INR 150000- INR 220000 Cost of PICC line insertion in Bangalore INR 140000- INR 215000 Cost of PICC line insertion in Delhi INR 140000- INR 215000 Cost of PICC line insertion in Chennai INR 130000- INR 210000

9) Who places or inserts the PICC line?

The team of doctors that insert the PICC line are- certified radiologists, trained radiology nurses, radiology physician assistant.

10) How is the PICC procedure performed?

Patient is placed on the procedure table, a tourniquet ( tube ) is placed around the arm just below the shoulder ( the arm in which PICC line is planned to be placed), the vein is selected using the ultrasound, local anesthesia ( numbing agent ) is injected, the vein is entered using the needle, the catheter is inserted via the vein and the needle is removed, this catheter is guided to the superior vena cava, the catheter is flushed with sterile normal saline to test whether the blood is flowing via it, final Xray is taken to confirm the catheter position and suture is placed to secure the catheter at the right position.

11) What must be done before the picc procedure?

The patient must undergo blood tests to look for potential bleeding disorders, anticoagulant medications if any must be stopped after doctor’s consultation.

12) Who can not get the PICC line?

The following patients can not get PICC line insertion- With INR value over 2.0 , major shoulder surgery, radiation therapy patients, vascular surgery, venous thrombosis, lymph node dissection, patients with cellulitis, burn injury, dermatitis, abscess or skin infections.

13) What are the complications of PICC line insertion?

The complications of the PICC line insertion are- local infections, bleeding, blood clot formation ( risk is 20 to 40 percent ),venous thrombosis, pulmonary emboli, allergic reactions to numbing agent, latex of the catheter, flushing solutions, contrast medium, breaking of the materials like guided wire or catheter tube during the procedure.

PICC Line Insertion at Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi

Minimum Price : 150000 Maximum Price : 220000

Symptoms

A PICC line is used for delivering medications directly to the large central veins near the heart. The doctor may recommend a PICC line insertion if the treatment plan requires frequent needle sticks for blood draws, or to give medication. PICC line insertion is normally temporary and may be an option if your treatment is going to last for many weeks.

A PICC line is recommended in the following cases:

Treatment for infections: Antifungal and antibiotic medications can be given through a PICC line for treating serious infections.
Cancer treatments: Medications for chemotherapy or targeted drug therapy, used for the treatment of cancer, can be delivered through a PICC line.
Total parenteral nutrition or liquid nutrition: If your body cannot process the nutrients obtained from food due to problems with the digestive system, a PICC line may be required to receive liquid nutrition.
Other medications: Certain medications may irritate the small veins. These medications can be given through a PICC line to reduce the risk of irritation to the small veins. The larger veins in the chest carry more blood, therefore, the medicines are diluted very quickly and it reduces the risk of injury to the veins.
Other procedures: PICC line insertion may also be done in case of blood transfusions, blood draws, and to receive a contrast material before an imaging test.

Diagnosis

Blood tests: The doctor may need to test the blood to make sure that you have enough platelets or blood-clotting cells. If you do not have enough platelets, there may be an increased risk of bleeding. Blood transfusion or medications can lead to an increase in the number of platelets in the blood.
Imaging tests: Imaging tests like x-rays and ultrasounds may be done to create images of the veins. This helps the doctor in planning the procedure.

Noting the medical history of the patient: Inform your doctor if you have had a mastectomy (breast removal surgery) which may affect the arm that is used for inserting the PICC line. Also, inform your doctor about any previous radiation treatments, arm injuries, or severe burns. Tell your doctor if you have a history of kidney diseases since a PICC line is generally not recommended in case of a dialysis (treatment for kidney failure) patient.

Treatment

The procedure takes about an hour to complete and is usually performed on an outpatient basis, that is, the patient can go home on the same day of the procedure and does not require an overnight hospital stay.
You will lie down in your back with your arm extended to the side.
A local anesthesia (the area of the procedure is numbed) will be used to minimize the discomfort.
A PICC line is normally inserted in a vein in the upper arm, above the elbow. Normally, the non-dominant arm of the patient is used.
An ultrasound may be used to assess the veins in the arm and make sure that they are healthy enough to be used for PICC line insertion. A cuff may be tightened around the arm so that the veins stand out for inspection.
Once a suitable vein has been identified, the area is cleaned and prepared.
A numbing medication is injected into the skin to minimize discomfort and pain.
A needle is inserted through the skin into the vein in the arm.
An x-ray or ultrasound may be used to confirm the placement.
A small cut (incision) is made in the vein so that a hollow, thin tube or catheter can be inserted.
Once the catheter is in the arm, it is carefully advanced along the vein.
The catheter continues up the arm, towards the heart.
An x-ray is taken or a heart-monitoring device is used to verify whether the catheter has reached the right place or not.
The other end of the catheter sticks out of the arm.
A cap is placed over the other end of the catheter to keep it germ-free. It may be taped downwards so that it does not interfere with the daily activities.

Risks

The risks associated with a PICC line insertion include:

Infection
Bleeding
Discomfort or pain
Blood clot formation at the wall of the vein or in the vein around the catheter
Pulmonary embolus (when one or more arteries in the lungs get blocked by a blood clot)
Deep vein thrombosis (blood clot formation in a vein deep in the body)
Cardiac arrhythmia (abnormal heart rhythm)
Allergic reactions to the anesthesia, latex, or other materials used during the procedure
Breakage of catheters or guide wires during the procedure
Contact your doctor immediately if you notice any of the following symptoms post a PICC line insertion:
PICC leaks
Port does not infuse or flush
PICC moves, and the part outside is longer than it was earlier
Chest pain or arm pain
Fever
Coughing
Shortness of breath
Heart palpitations (changes in the heartbeat)
Redness, soreness, or swelling around the PICC line

After Procedure

Inspect the exit site every day to check for any complications, like leaks.
Avoid the placement of tape over the site.
There may be some tenderness in the area, which usually goes away in a few days.
Ask about the best ways for securing the catheter.
Do not wear tight clothing, or use blood pressure cuffs, or use needles in the arm with the PICC.
Follow all the guidelines given by the doctor to clean and change the dressings.
Check the site for any signs of infection like bleeding, swelling, or flushed skin.
Use antiseptic cleansers to keep the site clean.
Cover the PICC exit site with a waterproof cover.
Avoid submerging the dressings in a pool or bathtub.
Avoid strenuous activities that may cause a PICC to become loose or come out.
Normally, the nurse will change the dressing and flush the line at least once a week.
A PICC line can stay in place for many weeks or months, depending on the type of procedure done.
The PICC line is removed when the treatment ends. The doctor or nurse will gently pull on the end of the catheter to remove it from the arm.
Removal of the PICC line reduces the risk of developing complications like infection.
If you require a PICC line again, the doctor may recommend keeping it in place. This is because placing the PICC line repeatedly will increase the risk of damage to the veins.