What is PICC line insertion?

BDS (Bachelor of Dental Surgery), 6 years of experience
What is the meaning of PICC line insertion?
A peripherally inserted central catheter or PICC line insertion is the insertion of a long tube through a vein in the arm or leg and passed to the larger veins near the heart.
A PICC line insertion is generally done to provide liquid nutrition or medications to the patient. It prevents irritation to the smaller veins in the arm and avoids the pain due to frequent needle sticks.
In this article, we will be discussing in detail about PICC line insertion.
- What is the purpose of PICC line insertion?
- What is the diagnostic procedure before PICC line insertion?
- How to prepare for PICC line insertion?
- What is the procedure of PICC line insertion?
- How to care after PICC line insertion?
- What are the risks of PICC line insertion?
- What is the cost of PICC line insertion in India?
What is the purpose of PICC line insertion?
A PICC line insertion is done to deliver medicines directly to the large central veins present near the heart.
It is generally recommended in case of treatments that are expected to last for many weeks, as an alternative to frequent needle sticks for drawing the blood or giving medications. A PICC line insertion is usually temporary and is done in the following cases:
- Parenteral nutrition: If the patient’s body is unable to receive adequate nutrients from the food consumed due to digestive system disorders, a PICC line may be required to provide liquid nutrition.
- Treatments for cancer: Chemotherapy drugs and targeted therapy drugs can be delivered via a PICC line insertion, for the treatment of cancers. ( Know more about- What is Chemotherapy? )
- Treatment of infections: Antifungal and antibiotic infections can be treated by medications given through PICC line insertion.
- Delivery of certain medications: Some medicines may be given through a PICC line to reduce the chances of irritation to the small veins. The larger veins in the chest area can carry more blood allowing the medicines to get diluted very quickly. This reduces the risk of injury to the veins.
- Other procedures: A PICC line insertion may be used for other procedures too, like blood transfusion, blood draws, or providing a contrast material before an imaging test like an X-ray. ( Know more about- What is Cardiac catheterization?)
What is the diagnostic procedure before PICC line insertion?
- Physical examination: The doctor will examine the overall physical health of the patient. Tell your doctor about your complete medical history. Any previous arm injuries, radiation therapy (a type of treatment for cancer), or serious burns should be reported to the doctor. Also, if you have a history of mastectomy (breast removal surgery), tell your doctor about the same as it may affect the arm being used for PICC line placement. If you have kidney disorders, or there is a chance of you needing dialysis in the future for kidney failure, a PICC line insertion is not recommended.
- Imaging tests: Imaging tests like x-rays and ultrasound may be needed to create pictures of the veins for planning the procedure.
- Blood tests: Blood tests are recommended to check if you have sufficient platelets (blood-clotting cells). An insufficient number of platelets may increase your risk of bleeding. Blood transfusions or certain medications can help in increasing the number of platelets in the blood. ( Know more about- What are Digestive Disorders? )
How to prepare for PICC line insertion?
- The doctor should be informed about any medical conditions that you may be having.
- Inform your doctor if you are currently taking any medications or supplements.
- Tell your doctor about any allergies that you may be having.
- You may be told to stop taking blood-thinners like warfarin and aspirin a couple of days before the procedure.
- If you are currently having illnesses like common cold or cough, tell your doctor about the same. The doctor may choose to delay the procedure until you feel better.
- You will be told to remove any devices that you may be having on the skin like an insulin pump or a continuous glucose monitor.
What is the procedure of PICC line insertion?
- The patient lies down on the back, with the arm extended to one side.
- A PICC line is then inserted in a vein in the upper arm, above the elbow region. Normally, the patient’s non-dominant arm is used for the same.
- A cuff may be tightened around the arm to allow the veins to stand out.
- An ultrasound machine may be used for the assessment of the veins in the arm and to make sure that the veins are healthy enough to be used for PICC line insertion.
- The skin around the vein selected for PICC line insertion is cleaned and prepared.
- A local anesthesia (numbing the area of PICC line insertion) is administered in the selected area to minimize pain and discomfort.
- A needle is then inserted through the skin, into the vein in the arm.
- The doctor may use an x-ray or ultrasound to confirm the placement of the PICC line.
- A small cut or incision is made in the vein to allow the insertion of a thin, hollow tube, known as a catheter.
- After the catheter is placed in the arm, it is carefully advanced along the vein.
- The catheter continues upward from the arm towards the heart.
- After the catheter reaches the right place, an x-ray may be taken to check its position. A heart-monitoring device may also be used to check its position.
- The second end of the catheter sticks out of the arm.
- A cap is placed over the open end of the catheter to keep it germ-free. It will be taped down to prevent any interference during daily activities.
- The procedure takes approximately an hour to complete, and the patient usually goes home on the same day of the procedure.
How to care after PICC line insertion?
- It is normal to experience some tenderness in the area of PICC line insertion. This usually goes on its own in a couple of days.
- Avoid taking blood pressure readings on the arm having a PICC line insertion.
- Avoid activities that strain your arm, like heavy lifting, and throwing a ball.
- Avoid swimming or using a hot tub, which could submerge the PICC line in the water.
- Cover the PICC line with a cover while taking a shower, and prevent the area from getting wet.
- PICC line covers can be worn daily to protect the area and make it less apparent to other people.
- Check the area daily for any signs of infection.
- Contact your doctor if you notice any of the following symptoms:
- Redness, swelling or bruising around the area of PICC line insertion
- Fever
- Shortness of breath
- Changes in the heartbeat
- The end of the catheter that sticks out of the arm tends to get longer
- Difficulty in flushing the PICC line, which could indicate a blockage
- A nurse will flush the PICC line with a solution every week to clear it from clogs.
- The PICC line can be kept in place as long as it is required for treatment. It can be removed once the treatment ends.
- The end of the catheter is gently pulled by the doctor or nurse to remove it from the arm.
- The removal of the PICC line lessens the chances of infection.
- If you are likely to receive a PICC line insertion again in the near future, the doctor recommends keeping the PICC line insertion in place, rather than removing it to prevent damage to the veins due to repeated placement of the PICC line.
What are the risks of PICC line insertion?
The complications associated with a PICC line insertion could include:
- Infection
- Bleeding
- Nerve injury
- Arrhythmia (irregular heartbeat) ( Know more about- What are the Arrhythmias of the heart? )
- Blood clot formation
- Damage to the veins in the arm
- Broken PICC line
- Blocked PICC line
- Need for replacement of PICC line or using a different type of central venous catheter
What is the cost of PICC line insertion in India?
The total cost of PICC line insertion in India can range from around INR 1,50,000 to INR 2,20,000. However, many prominent hospital doctors in India specialize in PICC line insertion. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of PICC line insertion, there will be an additional cost of living in a hotel and the cost of local travel. After the procedure, the patient is kept for one day in the hospital and seven days in the hotel for recovery. So, the total cost of PICC line insertion in India comes to a total of INR 1,90,000 to INR 2,70,000.
We hope that we could answer all your questions regarding PICC line insertion through this article.
If you need more information about PICC line insertion, you can contact a Radiologist.
We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan.