What is a PICC line?
A PICC line is a long, thin, flexible tube (catheter) inserted into one of the large veins of the arm, usually above the elbow. It is then gently threaded through the vein until the tip rests in a large vein near the heart.
The line is sealed with a special cap or bung, which can be attached to a drip or syringe for your chemotherapy or other medications. Sometimes the line has two or three separate channels, allowing you to receive different treatments at the same time.
What is a PICC line used for?
A PICC line can be used for various purposes:
- Chemotherapy
- Blood transfusions
- Antibiotics
- Intravenous (IV) fluids
- Liquid food (TPN) if you’re not able to eat
- To take samples of your blood for testing
How is a PICC line inserted?
A PICC line is usually inserted as an outpatient or day-case procedure. Before the procedure, Dr Nimit Goyal will discuss which arm is most suitable.
An ultrasound scan will be used to assess your veins. The skin is cleaned with antiseptic and numbed with a local anaesthetic. Using ultrasound guidance, a needle is placed into the vein, and the catheter is carefully threaded through the vein towards the heart. The needle is removed, and the PICC line is secured with a clear dressing.
Because the procedure is carried out on an X-ray table, Dr Goyal can confirm the exact position of the line straight away. This means a separate chest X-ray is not required.
Important information
How can I prepare for the PICC insertion?
The line is inserted under a local anaesthetic and you can eat and drink normally beforehand. Keep up your fluid intake as being dehydrated can make it more difficult to access the veins in your arm. Please take all your regular medications as usual, unless advised otherwise.
Wear loose fitting clothes particularly around the arms. Choose clothes in such a way so that the top can be removed easily if necessary.
Are there any potential problems when inserting a PICC line?
It can sometimes be difficult to thread the PICC line up the vein towards the heart. If this happens, we will try again using a different vein.
Sometimes, position of the PICC line may not be adequate and it may need to be repositioned. As Dr Goyal does the procedure on an X-ray table, this problem is avoided.
How do I care for the PICC line?
When the PICC line is not being used, there is a small risk of it getting blocked. To stop this from happening, once a week, a small amount of fluid is flushed into the line using a syringe.
The caps at the end of the line need to be changed each week to reduce the risk of infection. The dressing also needs to be changed every week. If it gets wet or starts to peel off, it should be changed sooner. It is difficult to change the dressing with one hand, so the nurses at the hospital may do it for you or arrange for a district nurse to visit you at home. They can also teach a relative, partner or friend how to change the dressing.
When you are at home, it’s safe for you to have a shower or bath with your PICC line in. Your nurse can give you waterproof covers to stop the line getting wet.
Can I exercise with a PICC Line?
Most normal daily activities are fine after the first day. Avoid strenuous exercise or heavy lifting until any oozing around the line has stopped.
However, you should avoid:
- Swimming (as it is difficult to keep the line and dressing dry)
- Sports with large arm movements, such as golf, tennis, or skiing (as the line could become displaced)
If exercise is very important to you, you may wish to discuss whether a Port-a-Cath is a better option.
Can there be problems with PICC lines?
The chances of problems are low with PICC lines. However, unfortunately as the PICC lines are external tubes, there are some potential problems.
Infection: Infection may develop inside the line or in the area under the skin where it goes into the vein. Contact your hospital doctor or nurse if you have:
- redness, swelling or pain in the area
- discoloured fluid coming from the area
- a high temperature (fever)
If you get an infection, you will be given antibiotics. If the infection doesn’t get better, the line will need to be removed.
Blood clots: A blood clot may form in your vein at the tip of the line or around the line within the vein. This usually causes difficulty in aspirating blood from the line or injecting fluids into the line. Regular flushing of the line especially when it is not being used helps prevent this. If a clot does form, you will be given some medication to dissolve it. Your line may have to be removed.
Air in the PICC line: It is important not to get any air into your PICC line. A cap (or bung) should always be placed at the end of the line (or each lumen if more than one lumen).
Line displacement: To stop the line coming out by accident, it should always be well secured with tape or covered with a dressing. If the dressing holding the PICC line in place becomes loose, please have it replaced as soon as possible.
How is the PICC line removed?
When you don’t need a PICC line any more, it can be taken out by gently pulling it out and the area where the PICC line was put in will be covered with a small dressing. This is a painless procedure and only takes a few minutes. It is done as an outpatient.