Peripherally Inserted Central Catheter (PICC)

Contents l What is a PICC? l Why do I need a PICC? l What are the alternatives? l Who will put in my PICC? l How long will it take? l How is the PICC Inserted? l How will the PICC affect me? l Problems with the PICC insertion l What can go wrong with PICCs? l How should I care for my PICC? l Useful Contact Information Heart PICC line enters body here PICC What is a PICC (Peripherally Inserted Central Catheter)? 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. The line then 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 or three lumens (known as double or triple lumen). 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. PICCs are also CT compatible, which means CT contrast can be administered through this line. Why do I need a PICC? Your doctor has decided that you require fluids or drug treatment into your bloodstream for a longer period of time or the drug you require has to be given through a large vein near the heart. A PICC should mean you will only require one more needle to insert the line which can stay in for the duration of your treatment. If necessary a PICC can stay in for up to 2 years. What are the alternatives? The alternatives to having a PICC are as follows: Repeated cannulae If you continue to have your treatment via a cannula you will require a new one to be inserted every 2-4 days. Over time your hands and arms will become sore and you will require a large number of needles. Midline This is similar to a PICC, but it is shorter and sits in the vein in the upper arm. Some medications can be given via this line but it depends on the type of medication and the duration of 1 2

your treatment. A midline can only stay in for up to 6 months. A different central line There are other types of central lines which can be inserted in the neck or chest. However, it has been decided that a PICC is more appropriate for your treatment. Who will put in my PICC? A specially trained nurse will put in the PICC. It can be done on the ward. Unless you are told otherwise you can eat and drink normally before and after. How long will it take? The placement of a PICC usually takes up to 60 minutes. This will allow time to explain everything, get all the equipment together, and check the line afterwards. How is the PICC inserted? First a local anaesthetic is administered either as a cream or with a needle under the skin and left for the skin to go numb. Next, a needle is used to locate a suitable vein above the elbow. The PICC will be fed up into the vein. The procedure is usually pain free, though some patients do feel some minor discomfort. You won t be able to feel the PICC being threaded up through the vein. The PICC is secured with an orange device called Securacath or with a Statlock. Once the PICC is in place it will be covered with a dressing. You will then need a chest x-ray to check the position of the line. As soon as it s in the right place, the PICC is ready to be used. A nurse will return the next working day to check your line and change the dressing. How will the PICC affect me? Your PICC will be put into your upper arm above the elbow, so you will be able to use your arm normally. Problems with the PICC insertion Most PICC insertions go smoothly, but occasionally there are problems. Sometimes, the shape of the vein can prevent the PICC from being threaded upwards. If this happens we will probably try again using a different vein. Sometimes the PICC goes in easily but the x-ray shows it is in the wrong position. When this happens we are usually able to adjust the position using a special flushing technique or by rethreading the same line. What can go wrong with PICCs? Many patients go through their treatment without having any problems with their PICC, but there are certain risks involved. It s important for you to know what can go wrong so you can help prevent problems or deal with them if they happen. The person putting in your PICC will spend time explaining this in detail. Potential problems Thrombosis (blood clot) Having a PICC sitting in a vein does mean there is a risk of causing a blood clot. This sounds very alarming but in fact when it does happen it s very unlikely to cause a serious problem. Patients who develop a clot due to their PICC are usually given medication to dissolve the clot. There is often no need to remove the line. Infection This can be a problem, particularly for patients who have a low resistance to infection or having intravenous feeding. Great care is always taken when putting the PICC in and when cleaning and flushing the line. Even so, infections can happen at any stage. Often infections can be treated with antibiotics, but sometimes we will need to remove the PICC to prevent the infection from getting worse. Palpitations Occasionally patients experience palpitations after the PICC has been put in. 3 4

Some patients describe this as a fluttering feeling in their chest. Other people say they are aware of their heart beating more strongly than normal or with a different rhythm. When this happens the PICC will be pulled out by a few centimetres and the palpitations will usually stop straight away. Not bleeding back A PICC is designed to allow blood samples to be taken, but sometimes blood cannot be withdrawn. This is not a serious complication but it can be disappointing - nobody likes having blood tests taken with a needle, putting a special flush down the line can usually solve the problem. Split Line It is very important to prevent the PICC from getting damaged - for example, you should never use scissors near it! If the PICC splits or breaks, it will need to be removed. Things to look out for If you experience cold and shivery attacks during and after flushing your line or if you have a temperature above 38 degrees centigrade, it is very important that you tell a member of nursing/ medical staff. When your line is not being used, remember to check daily for: l Redness l Tenderness l Oozing from where the line comes out of your arm l Hot to touch l Swelling of your arm l Leaking l Damage to your PICC If you have any of these problems please make someone aware as soon as possible. How should I care for my PICC? Your PICC should not stop you from doing anything that you would usually do and you should carry out your daily routine as normal. However, you should not put your entire arm in water. If you want to have a shower ask the ward nursing staff for a plastic cover/apron (or wrap some cling film around your arm if you are at home). Before using your PICC, Nursing and Medical staff MUST: l Wash their hands l Put gloves on l Clean the end of the line with a wipe for 30 seconds l Wait for 30 seconds l Flush PICC with normal saline l Use your PICC l Flush PICC with normal saline l Remove the gloves l Wash their hands. This is to protect you and other patients from any infections. Your PICC will always be covered by a dressing to protect it. Do not peel the dressing away and always tell the nurse if the dressing becomes loose, dirty or wet and the ward staff will change it. Otherwise the dressing will require changing once a week and this will be done by a member of nursing staff. Further Information If you have any questions about PICCs please don t hesitate to ask your nurse or doctor. Contact information Hospital IV Access Team 0161 206 0459 IV Team Infection Control Salford Royal NHS Foundation Trust, Stott Lane Salford M6 8HD 5 6

G17083003W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: TE 11 (17) Review Date: September 2019 University Teaching Trust For further information on this leaflet, it s references and sources used, please contact 0161 206 0459. Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance. If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately. Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients