Peripherally inserted central catheter (PICC)

Overview

A peripherally inserted central catheter (PICC) is a thin, flexible tube inserted into a vein to allow for easy access to the bloodstream. A PICC line is a type of catheter used to access the large veins in the chest, known as a central venous catheter. It can be used to give treatments and draw blood for tests.

A PICC, also known as PICC line, allows for the administration of medications or nutrition directly into the bloodstream, reducing the need for frequent needle sticks and preventing irritation to smaller veins. While beneficial, a PICC line requires careful monitoring and maintenance to prevent complications such as infections or blood clots.

Reasons for undergoing the procedure

A PICC line offers more comfort compared to repeated needle sticks needed for administering medications and drawing blood. Specifically, it helps protect the patient’s veins from frequent needle use and the irritating effects of IV medications. It can also be used for blood draws, transfusions, and administering contrast for imaging tests.

A PICC line is used to deliver medications and treatments directly into the large veins near the heart. It is often advised for specific treatments, such as:

• Infection treatments. For severe infections, a PICC line can be used to administer antibiotics and antifungal medications.
• Treatments for cancer. A PICC line can be used to provide medications that are administered through a vein, including certain chemotherapy and medicines used in targeted therapy.
• Total parenteral nutrition. One might require a PICC line to receive liquid nutrition if digestive system issues prevent the body from processing nutrients from meals.
• Other medications. The larger veins in the chest have more blood flow, which helps to quickly dilute the medications, minimizing the chance of vein irritation or injury. Some medications can irritate small veins, but using a PICC line reduces this risk.

Risk

The PICC insertion procedure may cause minor discomfort, and bleeding can occur at the insertion site. There is a small chance of accidental puncture of nearby arteries, nerves, or tendons, and it might take multiple attempts to insert the catheter fully.

Some complications can be treated without removing the PICC line, but others may require its removal. In such cases, placing another PICC line or using a different type of central venous catheter may be suggested.

Common complications of a PICC include:

• A clogged or damaged PICC line
• Injury to the veins in the arm
• Blood clot formation
• Irregular heart rhythms
• Bleeding
• Nerve damage
• Risk of infection

Before the procedure

Before getting a PICC line, it is important to inform the healthcare provider of the following as these factors can influence where the PICC line is placed, or if a PICC line is still advisable:

• Any history of kidney disease 
• Need for dialysis in the future
• Undergone breast removal surgery
• Had radiation treatment
• Had previous arm injuries
• Had serious burns

Several tests may also be required prior the insertion, such as:

• Blood tests. One might undergo blood tests to ensure sufficient platelet levels, as low platelets could increase the risk of bleeding. If necessary, treatments like medication or blood transfusions can help boost platelet counts.
• Imaging tests. To visualize the veins and plan the procedure, ultrasounds or X-rays are typically requested.

During the procedure

The PICC line insertion procedure typically takes about an hour and can be done on an outpatient basis, meaning no hospital stay is required. It is usually performed in a designated procedure room equipped with imaging technology, such as X-ray machines, to guide the insertion. If the patient is already admitted to the hospital, the procedure may be performed in their hospital room.

Most people experience little to no discomfort during the procedure and can use their arm normally once the PICC is in place. In some cases, a numbing medicine is used to minimize discomfort.

The PICC line is usually inserted into a vein in the upper arm, above the elbow. The nondominant arm is typically preferred, depending on the one’s condition.

A PICC line insertion is done as follows:

• One lies down on their back with the arm extended to the side.
• Using an ultrasound machine, the veins in the arm is assessed, ensuring they are healthy enough for the PICC line. A cuff may be applied to the arm to make the veins more prominent for inspection.
• After identifying a suitable vein, the skin around the area is cleaned, and numbing medicine is injected to reduce pain.
• A needle is inserted through the skin into the vein, with ultrasound or X-ray guidance used to confirm its placement.
• A small incision is made in the vein, allowing a thin, hollow tube (catheter) to be inserted. 
• The catheter is carefully advanced through the vein, up the arm, and toward the heart.
• The correct position of the catheter is confirmed either by an X-ray or, if the procedure occurs in a hospital room, by using a heart-monitoring device. If an X-ray was not performed during the procedure, it may be done later to verify the placement.
• The external end of the catheter is capped to keep it sterile and may be taped down to prevent interference with the one’s daily activities.

After the procedure

As an individual adjusts to living with a PICC line, it is important to consider the following:

• Protecting the PICC line: Submerging the PICC line in water, such as while swimming or using a hot tub, should be avoided. It is also advised to avoid heavy lifting, not having blood pressure readings taken on the affected arm, and steer clear of activities that could jolt the arm, such as throwing a ball.
• PICC line covers: There are also various covers available for daily use that can help protect the area or make the line less visible to others. Healthcare providers might supply a cover, or one can be purchased at a pharmacy. It is essential to cover the PICC line when showering to prevent the area from getting wet.
• Caring for the PICC line: Having assistance with PICC line care can be beneficial and hiring a home healthcare provider might be considered if additional help is needed. Caring for the PICC line typically involves daily inspection for signs of infection and flushing the line with a solution weekly to keep it free from clogs.

Outcome

It is important to ensure that the PICC line is kept in place. Potential complications should be regularly monitored. Seek immediate medical attention if any of the following is experienced:

• Irregularities or changes in their heartbeat
• Fever
• Shortness of breath
• Exposed portion of the catheter seems longer than it was initially
• Difficulty flushing the PICC line, indicating a possible blockage
• The area surrounding the PICC line appears increasingly red, swollen, bruised, or warm to the touch

A PICC line is kept in place as long as it is needed for treatment and can be removed by a healthcare professional when treatment is complete. Removal involves gently withdrawing the catheter from the arm, which helps minimize the risk of complications like infection. If there is a possibility of needing a PICC line again in the future, the clinician might suggest leaving it in place, as multiple insertions can increase the risk of venous damage.