Insertion of a PICC (Peripherally Inserted Central Catheter) / Mid Line Department of Radiology Information for Patients i Radiology Leaflet No. 85 University Hospitals of Leicester NHS Trust
Referral and consent The doctor who referred you should have discussed the reasons for needing a PICC or Mid Line. You should make sure that you understand these reasons, the procedure itself, any risks involved and the success rates. You will meet a member of the vascular access team before you have the procedure, but this is not usually until the day of the procedure. The radiologist (a specialised X-ray doctor) or specialist nurse who will be performing the procedure will ask you to sign a consent form. When you sign this it means you have agreed to have the procedure done and that you understand why it is needed. You should have had sufficient explanation before you sign the consent form. You will have a copy of the consent form to take away. If after this discussion you do not want the procedure carried out then you can decide against it. If you feel during the procedure that you do not want it to continue we will explain the implications of not doing so, to help you fully decide. If the radiologist or nurse feels that your condition has changed or that your symptoms do not indicate the procedure is necessary then they will explain this to you. They will let the doctor who referred you know so that they can see you again to review your condition. At all times the radiology team and referring doctor will be acting in your best interests. 2
What is a PICC / Mid Line? A PICC and Mid Line are both thin flexible tubes called catheters that are inserted into one of the large veins in your arm. Diagram showing a Mid Line in a patients arm. A Mid Line is positioned from your elbow to the top of your arm, at the midway point to your heart. Diagram showing a PICC in a patients arm. A PICC is positioned from your elbow and has the tip sitting just above your heart. 3
Why do I need a PICC / Mid Line? A PICC / Mid Line can be used to give you treatments, such as chemotherapy, antibiotics and intravenous fluids. This means you won t need to have needles into the veins in your arms every time you have treatment. You may be able to go home with either of these catheters in place. A Mid Line can remain in place for up to one month and a PICC for up to a year. These catheters are a secure and safe method for administering drugs and medicines that cannot be given through smaller veins and can last for the duration of your treatment. Before your procedure A specialist nurse will assess your veins to see if they are suitable to have a PICC or Mid Line and will arrange an appointment for you to have the line inserted. If they decide that a PICC or Mid Line would not be suitable for you, they will be able to discuss possible alternatives with you. Most people who have this type of procedure can have it done as a day case procedure. However there may be other reasons why you have to stay in hospital for longer and your doctor will discuss these with you before you decide to have the procedure. You can eat and drink normally before the procedure. 4
How is the PICC / Mid Line inserted? Both lines are inserted into a large vein usually near the bend of your elbow. A cannula is inserted into the vein and then the catheter is threaded through the cannula and up the vein in the arm. To have the PICC / Mid Line inserted you will be asked to lie flat with your arm out. Your skin will be cleaned with antiseptic and you will have some of your body covered with a sterile sheet. A small amount of local anaesthetic will used to numb the skin. The line will usually be inserted in a room with an X-ray machine so that we can check the location of the end of the line during insertion. The procedure should take about 20 minutes. What are the possible complications? As with any procedure or operation, complications are possible. Complications with PICC / Mid Lines are rare, but it is important that you are made aware of these. We have included the most common risks and complications in this leaflet. Infection There is a risk of you getting an infection in the line, but the risk is slight because the line is put in under sterile conditions and a sterile dressing always covers the insertion site. The dressing should be replaced weekly. Patients having chemotherapy will be more at risk of infection due to the effects of their treatment on their immune system. 5
What are the possible complications? (continued) If you have any of the following, please contact your hospital doctor or nurse immediately: Discoloured fluid coming from the insertion sites. Redness or pain around the line. If you have a temperature or feel shivery. Blood clot (thrombosis): When a catheter sits in a vein there is an increased chance of a blood clot forming in the vein. If this occurs you may notice that your hand or arm swells up. If this happens you will need to contact the hospital. It is advisable to do some light exercises and continue to use the arm as normal as this will help the flow of the blood in the vein, so helping to prevent clots. Inflammation (phlebitis): Once the PICC or Mid Line has been inserted into the vein it can sometimes irritate the wall of the vein. This can cause some soreness and redness in the arm with the line in. If you have any of the following, please contact your hospital doctor or nurse immediately: Redness or pain around the line. If your arm feels hot to touch. If you experience any of these complications, or you are worried about anything to do with your PICC / Mid Line, please contact the hospital immediately. 6
What happens after the procedure? Eating and drinking: You may eat and drink normally before and after the procedure. Getting around: You will be able to get up and move about immediately after the procedure. Leaving hospital: Most people who have had this type of procedure under local anaesthetic will usually be able to leave hospital after an hour. Resuming normal activities, including work: Most people who have had this procedure can resume normal activities by the next day but you may have a little discomfort in your arm. You might need to wait a little longer before resuming more vigorous activity. When you will be ready to return to work will depend on your usual health, how fast you recover and what type of work you do. Please ask your doctor or nurse specialist for their advice Care of the PICC / Mid Line Dressing the line: The PICC / Mid Line is secured to your arm with a special dressing and can be covered with a tubular bandage for security, if you wish, as long as it is not tight. To help prevent infection the dressing will be removed, the skin cleaned and a new dressing put on every week. This could be done by either your district nurse or the hospital nurse. If the dressing becomes loose or tatty ask the nurse to change the dressing as soon as possible. 7
Care of the PICC / Mid Line (continued) When the nurses are changing your dressing it is recommend that you make a note of the amount of the catheter showing from the skin to the end of the line. If there appears to be 3cm more line than usual showing please inform the hospital immediately. It is important that you do not get the PICC / Mid Line dressing wet. If you usually have a shower you will need to cover your arm with a waterproof sleeve. The nurse who inserts your line will be able to give you advice. You will not be able to go swimming while you have a PICC / Mid Line inserted. Flushing the line Your PICC / Mid Line will need to be flushed weekly with heparinised saline to keep it open and stop the line getting blocked. This could be done by either your district nurse or the hospital nurse. The white clamp must be kept closed when the line is not in use. This should always be on the thick reinforced part of the line. Needle free device (caps) You should also ensure the needle free device on the end of the line is always in place. You should contact the district nurse or the hospital if the needle free device falls off: NEVER replace it with a dirty device. You will be given a four-week supply of equipment that the district nurse requires to care for the line when you are discharged from the hospital. 8
Information and support If you have any questions or concerns, please feel free to ask a member of staff or contact a member of the vascular access team. The vascular access team can be contacted as follows: During normal office hours on 0116 258 6861 Outside of normal office hours via the main hospital switchboard 0300 303 1573. Alternatively you can contact your hospital doctor with any concerns you may have 24 hours a day. You can do this via the main hospital switchboard 0300 303 1573. If you are a chemotherapy patient and have any problems or need advice you should contact the chemotherapy suite immediately. Any questions? If you have any questions write them down here to remind you what to ask when you speak to your consultant or radiologist. 9
Support for people with learning disabilities There is support available in our hospitals for patients with learning disabilities. Please contact the learning disability specialist nursing team on (0116) 258 4382 telling them when the appointment is and what examination has been booked. Other sources of information Websites For general information about radiology departments visit the Royal College of Radiologists website: www.goingfora.com For information about the effects of x-rays read the NRPB publication: X-rays how safe are they, on the Health Protection Agency website: www.hpa.org.uk Please note that the views expressed in these websites, do not necessarily reflect the views of UHL or the NHS. University Hospitals of Leicester website: www.leicestershospitals.nhs.uk NHS Direct: For health advice or information you can call NHS on: 111. 10
Additional hospital information How was it for you? If you wish to make any comments or suggestions regarding your visit to the Radiology Department please fill in a suggestion form or speak to a member of staff. Suggestion forms are located in all waiting areas within the department. University Hospitals of Leicester NHS Trust also has a Patient Information and Liaison Service (PILS), and you are welcome to contact them on: Freephone: 08081 788337 email: pils.complaints.compliments@uhl-tr.nhs.uk We review our information leaflets on a regular basis. If you have any comments about how we can improve these leaflets please speak to a member of staff. Directions and car parking Hospital car parking is available to all hospital patients and visitors. Spaces are limited so please allow plenty of time to find a car parking space. Parking charges are payable, please check tariff boards or the hospital website for full details. As well as the hourly rates there are a range of saver tickets available for patients and prime carers. Dedicated disabled parking bays are also available. Marked disabled bays exist outside of the public car parks for which there is no charge. If you park in the car parks the fee will apply. Drop off bays exist at the main entrances, these bays have a 20 minutes maximum stay. Certain qualifying benefits as notified by the Department of Social Security entitle the patient to free or reduced parking. For more information contact the Cashiers office. 11
Additional hospital information (continued) Bus services to the hospital Our aim is to ensure that there are car parking spaces available for those who really need to use them. We encourage you to use public transport or walk to the hospital if you are fit and well. For information on bus routes and times contact Traveline on 0871 200 2233. Our Hospital Hopper shuttle bus service links our three hospitals with Beaumont Leys Centre, Hamilton Centre, the Railway station and St Nicolas Place (Park and Ride hub). The buses run from 6:30am until 7pm every 30 minutes from Monday to Friday. The nationally recognised concessions are valid on buses in Leicester including the Hospital Hopper. Contact the UHL Travelwise Manager on 0116 258 3796 for more information on the Hospital Hopper. Relatives and escorts You may wish to bring a friend or relative to accompany you to and from the Radiology Department when you have your examination although they may not always be allowed into the examination room. This may be useful if you do not understand English very well or if you have any special needs. Children Baby changing facilities are available. Please ask to be shown to them if you wish to use them. We are unable to offer childcare facilities. If you need to bring your children with you, please bring along an adult who can supervise them whilst your examination is being carried out. Radiology staff are not able to supervise your children. 12
Additional hospital information (continued) Facilities available Refreshments: Refreshments including hot and cold drinks are available in the hospital. Please ask a member of staff for directions. Shops: Each hospital contains a shop selling magazines, newspapers, sweets and drinks. Please ask a member of staff for directions. 13
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Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on 0116 250 2959 Produced by: Imaging Patient Information Group. Edition 2. Date implemented: November 2014. Review date: November 2018. (Mear)10148450KR IMA082-1014