PICC Line Insertion

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.

1. 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.

2. 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.

1. 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.

2. You will lie down in your back with your arm extended to the side.

3. A local anesthesia (the area of the procedure is numbed) will be used to minimize the discomfort.

4. 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.

5. 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.

6. Once a suitable vein has been identified, the area is cleaned and prepared. 

7. A numbing medication is injected into the skin to minimize discomfort and pain.

8. A needle is inserted through the skin into the vein in the arm.

9. An x-ray or ultrasound may be used to confirm the placement.

10. A small cut (incision) is made in the vein so that a hollow, thin tube or catheter can be inserted.

11. Once the catheter is in the arm, it is carefully advanced along the vein.

12. The catheter continues up the arm, towards the heart.

13. An x-ray is taken or a heart-monitoring device is used to verify whether the catheter has reached the right place or not.

14. The other end of the catheter sticks out of the arm. 

15. 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.

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
  

• 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.