Management of a PICC line (Peripherally inserted central catheter)

What is a PICC line?

A PICC is a long, thin, flexible tube known as a catheter. It is inserted into one of the large veins of the arm near the bend of the elbow. It is then pushed into the vein until the tip sits in a large vein just above the heart.

The space in the middle of the tube is called the lumen. Sometimes the tube has two lumens. This allows different treatments to be given at the same time. At the end of the tube outside the body, each lumen has a special cap to which a drip line or syringe can be attached. There is also a clamp to keep the tube closed when it is not in use.

What is it used for?

The PICC line can be used to give you treatments such as chemotherapy and antibiotics. It can also be used to take samples of your blood for testing. You can go home with the PICC in and it can be left in for weeks or months. This makes it possible for you to have your treatment without having to have needles frequently inserted into your veins. This may be particularly helpful if your veins are hard to find or have been hardened by previous chemotherapy treatment.

How is the catheter put in?

Your PICC will be put in by a specially trained nurse or doctor, in an outpatient department or on the ward. It will be put in using a local anaesthetic, so that you do not feel any pain.

First, the skin in the area where the PICC will be inserted is numbed, using a special anaesthetic cream. When the skin is completely numb a needle will be inserted and then removed as the PICC is threaded through it into the large vein which leads to your heart. This should not take long and is usually painless. The PICC will be held securely in place by a transparent dressing. You will then have a chest x-ray to check that the end of the tube is in the correct position.

Possible problems when putting in the PICC

If your veins are small, it may be difficult to put the PICC in. Sometimes it can be difficult to thread the PICC up the vein towards the heart. If this happens, it is possible to try again using a different vein.

Sometimes the PICC seems to go in easily but the x-ray shows it is not in the right place. If this happens it will be taken out and replaced.

How do I care for my PICC?

When the catheter is not being used there is a slight risk that it may become blocked. To stop this happening a small amount of fluid is flushed into the catheter using a syringe. This is done regularly, usually once or twice a week. The dressing will also need to be changed each week to reduce the risk of infection.

As it is difficult to do this yourself with one hand, the nurses at the hospital may do it for you or arrange for a district nurse to visit you at home. A partner, relative or friend can also be taught to do this if they feel happy to.

Possible problems

Infection

It is possible for an infection to develop inside or around the place where the catheter goes into the vein. If this area becomes red, swollen or oozes, or if you develop a temperature, you should tell your doctor. You may be given antibiotics, or, occasionally, the catheter may have to be removed.

Clots

It is possible for a blood clot (thrombosis)to form in your vein at the tip of the PICC. You may be given a tablet to take each day to help prevent this. If you do develop a blood clot the line may have to be removed. You will then be given medicines to dissolve the clot.

Air in the catheter

Air must not be allowed to get into your catheter. The clamps should always be closed when the line is not in use. The line must not be left unclamped when the caps are not in place.

Break or cut in the PICC

It is important that the PICC line is not cut or split. Do not use scissors near the PICC. If it does get damaged you should contact your doctor immediately as it may need to be removed, if it cannot be repaired while still in place.

How is the PICC removed?

When you no longer need a PICC it will be taken out. A nurse will usually do this for you in an outpatient department. It will be gently pulled out. This is a painless procedure that takes only a few minutes.

References

This section has been compiled using information from a number of reliable sources including:

  • Oxford Textbook of Oncology (2nd edition). Souhami et al. Oxford University Press, 2002.
  • Cancer and its Management (4th edition). Souhami and Tobias. Oxford Blackwell Scientific Publications, 2003.
  • The Chemotherapy Source Book (3rd edition). M.C. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see the general bibliography.

Management of a PICC line (Peripherally inserted central catheter)

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