PICC Line Insertion
What is a PICC line?
PICC (Peripherally Inserted Central Catheter) is a long soft plastic tube inserted through a vein in the arm to reach the large central vein in the chest. A PICC line can be used to administer strong antibiotics, TPN (total parenteral nutrition), chemotherapy drugs, and blood transfusions. It can also be used for blood sample collections and contrast injection for scans.
What advantages do PICC lines offer over peripheral venous cannulas?
A PICC line allows administration of medications that have the potential to cause damage to the small veins in the arms if given through an ordinary peripheral cannula. While peripheral venous cannulas need to be replaced every 3 to 4 days, a PICC line can remain in place for weeks to months.
PICC lines allow greater freedom of arm movement when inserted above the elbow joint.
How is a PICC line inserted?
Your PICC line will be inserted by an interventional radiologist in an angiographic suite. You will be given a local anaesthetic to numb a tiny area of skin. Under ultrasound guidance, a small needle is inserted into a vein in the upper arm. A guidewire is passed into the central vein under X-ray guidance. The length of the PICC line is trimmed with the help of the X-ray. The PICC line is then inserted until the tip reaches the large central vein. A small amount of X-ray dye is injected to make sure the tip is in the correct position.
What medical conditions should I inform the PICC line insertion team?
It is essential that you notify the team if you have a pacemaker, if you are pregnant, if you've previously had an allergic reaction to intravenous contrast, or if you have previously had breast cancer surgery involving the removal of lymph nodes under the armpit.
What are the risks of PICC line insertion?
PICC line insertion is considered to be an extremely low risk procedure. The guide wire might trigger a run of extra heartbeats. Bruising and minor bleeding around the insertion site may occur.
What potential complications may arise over the course of PICC line usage?
Complications with use of PICC line are rare. If you develop symptoms described below, you need to inform the treatment team immediately.
Venous thrombosis (blood clots). Blood clots in veins rarely forms as a result of the PICC line rubbing against the wall of a vein. The symptoms are pain and swelling in the arm, neck, or face.
Infection. Pain, warmth, or redness around the insertion site; fever, chills and shakes are signs of infection.
How is a PICC line removed?
Your PICC line can be removed by a trained nurse when you no longer require intravenous therapy. This is a quick and painless procedure that involves gently pulling the PICC from the insertion site. A sterile dressing will be applied following its removal.
General PICC Line Care
Always keep the dressing dry. For showering or bathing, the dressing must be protected from water. While the dressing is water resistant, it is not water proof and water can track along the PICC line from under the dressing.
Be cautious not to pull on the line. This is especially important when you have IV therapy connected. The line is usually held in place by an adhesive fixation device as well as the dressing but if pulled hard enough it will still come out. If it comes out part way DO NOT PUSH BACK IN as this can lead to infection. Let your treatment team to determine if it is still in far enough to be used or if it needs replacing. If it comes all the way out, you will need to apply gentle pressure to the puncture site for 2-3 minutes to stop the bleeding.
A good way to prevent the lines getting caught and pulled out is to cover the line with a bandage or tubular dressing when not in use.
Notify your treatment team if you noticed the following:
A temperature higher than 38° C or feeling unwell; redness, pain, swelling around your PICC line; redness, pain or swelling in your arm, neck or chest area, shortness of breath, chest pain or fast heartbeat; damage or a break or split in the PICC line.
If you can’t contact your doctor or nurse, go to the nearest hospital emergency department.
What is Interventional Radiology (IR)?
IR is a subspecialty of radiology. Interventional radiologists apply minimally invasive therapy using imaging guidance such as X-ray, ultrasound and CT scan. IR procedures are typically performed under local anaesthetics. Intravenous sedation and analgesia may be required in some procedures. It is generally less risky than open surgery and the recovery is usually faster.