About your PICC line Information for patients Weston Park Hospital
This booklet explains what a PICC line is, how it is inserted and some general advice on its use and care. What is a PICC line? A Peripherally Inserted Central Catheter (or PICC line) is a soft flexible plastic tube which is inserted into a vein in your arm. How will it help me? A PICC is one of several ways that we use to give you fluids and medication, for example antibiotics, intravenous feed and chemotherapy. If you have problems having blood samples taken from a vein it may be possible to take blood samples from your PICC. You need to arrange this with the nurses in the area where you will receive your treatment. Blood samples cannot be taken from PICC lines by phlebotomists. page 2 of 16
How is a PICC line put in? To help us ensure that the insertion of your line goes smoothly, please wear comfortable clothing that will allow us to get to your upper arm. Do not wear clothing with metal buttons and motifs as these will show up on X-ray and make it more difficult for us to see if the line is in place. The person who puts your line in will explain the procedure to you. You will be asked to sign a consent form to say that you have understood this information, and the potential risks and complications associated with the insertion and use of a PICC line. Local anaesthetic cream may be used to numb the skin on your arm. This will take about one hour to work. During the procedure you will be given an injection of local anaesthetic. It is very important that PICC lines are inserted under sterile conditions to minimise the risks of infection. Your arm will be cleaned with an antiseptic and covered with sterile paper sheets. You will be able to talk to the nurses caring for you during the procedure. Once the vein has been accessed the PICC line will be moved along until the tip reaches the large vein in your chest. You should not feel this part of the procedure. When the line is in place it will be covered with a dressing to keep it clean and to hold it in place. Before your line can be used you will need an X-Ray to check that it is in the right position. page 3 of 16
Diagram showing the position of a PICC Does it hurt? You will be given an injection of local anaesthetic into your skin before the line is inserted. The local anaesthetic may sting when it is injected, but this wears off after a few seconds. The anaesthetic should remove any sharp sensations, but you may be aware of a pressure sensation during the procedure. Most people tolerate this well although it feels slightly strange. Occasionally, people find it uncomfortable and if this is the case, please let the staff caring for you know. Once the local anaesthetic has worn off you may experience some tenderness or discomfort for a few days around the area where the line has been inserted. page 4 of 16
How long does it take to put a PICC line in? If a local anaesthetic cream is used, you will need to wait an hour for this to work before your PICC is put in. Inserting a PICC line usually takes about 45 minutes (but in some cases it may take much longer). Usually you can expect to be in the hospital for several hours. Will I be able to feel the line once it is in place? You may feel a heaviness or tenderness in your arm for the first 24-48 hours after your PICC has been inserted. However, after that you will become less aware of the line being there and you should find that you are able to continue with your normal activities. Please avoid heavy physical activity as this increases the risks of developing an inflammation in the vein in your arm and of dislodging your PICC. How soon after the line has been inserted can I go home? You can go home once the X-Ray has been checked to make sure that your PICC is in the correct position. You do not have to stay in hospital. Before you go home you will be given the equipment needed to care for your line. page 5 of 16
How long will I need my PICC? How long the line stays in will depend on the treatment you are having. However, PICC lines can be safely left in place for several months or longer if necessary. Are there any risks? Whilst having a PICC is a safe procedure it is important that you are aware of the risks and complications that can occur. Problems can occur both during and after the insertion of the line. The person inserting your PICC will explain the risks and complications to you and will be able to discuss any concerns you have. What problems can occur during or immediately after your PICC is inserted? Difficulty in accessing a vein or inserting the PICC If you usually experience problems when having blood samples taken it may make inserting a PICC difficult or not possible. If we have difficulty or are unable to insert a PICC we will stop the procedure and discuss other options with you. The tip of the line does not reach the correct position After your PICC is inserted you will have an X-Ray to check that it is in the correct position. If your line is too long or is not in position we can sometimes shorten it or move it to a better position. This is a very minor procedure and will be done the same day. page 6 of 16
Bleeding or bruising from around the insertion site It is normal in the first 24 hours after your line is inserted for you to experience some bleeding at the site of insertion. You may also have some bruising but this will clear up within a few days. In some cases a small amount of bleeding can occur for up to several weeks (contact Weston Park Hospital if you are concerned). What other problems can occur? The most common problems that can occur with PICC lines are: Infection in or around the line Formation of a blood clot around the line Inflammation along the vein where the PICC is inserted (mechanical phlebitis) The line becoming blocked The line splitting The line moving out of position or falling out If you have any of the problems listed above and have your treatment under the care of Weston Park Hospital you should ring Sheffield Teaching Hospitals NHS Foundation Trust and ask for the Nurse Practitioner at Weston Park Hospital. page 7 of 16
Infection in or around your line How will I know if I have an infection in my PICC? Infection can develop into a serious problem, particularly if you are receiving chemotherapy or intravenous feed. This means it is important that you know how to recognise the signs of infection. These are: Pain, redness or swelling around the line Feeling hot and shivery, or cold and shivery or feeling generally unwell. It is particularly important if this happens after your PICC has been flushed A temperature above 37.5ºC. Discharge from the skin at the exit site How can I reduce the chances of getting an infection in my line? You can reduce the chances of getting an infection by keeping your PICC clean and dry. The following will help you to do this: Always wash your hands before touching your PICC Avoid touching the line except when it is being cleaned or dressed You should have your line flushed and the dressing changed in a clean area. Do not let the area around your PICC get wet. Waterproof gloves or sleeves are available to help keep your PICC dry in the bath or shower The person inserting your line will be able to advise about this Change any dressings as soon as possible if they become wet or soiled Don t allow a doctor or nurse to touch your PICC unless they have washed their hands and they are wearing sterile gloves, as they page 8 of 16
come into contact with more infections and have to be extra careful not to spread them to PICC lines Formation of a blood clot It is possible for a blood clot to form in the vein where your line is placed. Generally this type of blood clot is not a serious problem but it can become serious if you do not seek advice or get treatment. How will I know if there is a blood clot in or around my line? If you notice any of the following signs in the arm where your PICC line is: Pain, ache or tightness in the shoulder, armpit or neck Swelling of the fingers, hand or arm Discolouration of the skin (usually it will be a darker blue/purple colour compared with the opposite arm) What would happen if I had a blood clot around my line? If we thought you had a blood clot we would arrange for you to have an ultrasound scan to confirm if this was the case. If the scan showed a clot around your line you would need to have a daily injection to thin your blood and allow your body to dissolve the clot. A district nurse can give you this injection or you or a relative could learn to do it. You will need these injections for several months. You will be asked to have a blood test approximately 7 days and 14 days after you started the blood thinning injections. This can be done at your own GP s surgery or at the hospital where you are receiving treatment. page 9 of 16
This blood test is to check that the injections have not made your blood too thin. If you have a blood clot, your PICC will usually be left in place and you would continue with your treatment. Occasionally, the line would need to be removed. Inflammation It is not unusual for your PICC line to irritate the lining of the vein and cause inflammation. This is called mechanical phlebitis. How will I know if I have mechanical phlebitis? Mechanical phlebitis is most likely to happen in the first week after your PICC has been inserted, although it can happen at any time. The signs of mechanical phlebitis are similar to those of infection, for example you may notice redness or swelling of your arm above the area where the line goes in. However, the difference between this and infection is that you should not have a high temperature, feel unwell or have a discharge from around your line. If you are not sure whether you have an infection or mechanical phlebitis please follow the contact advice as given above. How can I prevent / treat mechanical phlebitis? You can reduce the chances of getting mechanical phlebitis by applying a heat pack to your arm for the first 3 days after your line has been inserted. We advise that you do this for 10 minutes, four times a day. To make a heat pack, you can use a hot water bottle filled with warm water or a wheat pack warmed in the microwave. Please make sure that the heat pack is not too hot because it may burn your skin. page 10 of 16
If the redness or swelling does not get better after 24 hours or if you become unwell, you must phone the hospital where you are receiving treatment for advice. Bleeding from around your PICC It is normal in the first 24 hours after a PICC is fitted for you to experience a small amount of bleeding from where the PICC goes in. However, if the bleeding leaks through the dressing, apply firm pressure over the area using a clean pad, for example, a tea towel. If the bleeding continues follow the contact advice as given above. Line blockage How will I know if my line is blocked? Your PICC will be flushed weekly to keep it working properly. If the person who is flushing the line is unable to do so easily it may mean that your line is blocked. Do not try to force fluid through a blocked line. The line becoming dislodged or falling out After your PICC is inserted you will have an X-Ray to let us know where the end of the PICC is. It is possible for the line to move from this position at any point after it has been inserted. If your PICC moves out from this position it may no longer be safe for us to use it. How will I know if the line has dislodged? The PICC is held in by a dressing and, depending on the treatment you are receiving, an additional securement device. The amount of your PICC visible on the outside should be recorded on your dressing each time it is changed. It is helpful if you can remember page 11 of 16
how much of your PICC you can normally see, so that you are able to tell if it has moved from its original position. If you line looks longer than usual you will need to follow the contact advice as given above. To prevent the line being pulled it should be secured using tape or a securement device such as a statlock. This is especially important when you are on a drip or are having chemotherapy through an infusor bottle. It is also important to avoid your PICC being pulled when the dressing is being changed. You can help to prevent this by placing a thumb or finger over the dressing, at the point where the PICC goes into your arm, when the dressing is being removed. It is also helpful to ensure that your arm is well supported on a pillow when your dressing is changed. If you experience a pain or an aching feeling in your neck, jaw or teeth on the side where you have your PICC, particularly if this occurs as your PICC is being flushed, please follow the contact advice as given above. What should I do if my PICC falls out? This is a rare occurrence if this should happen, cover the site with a clean piece of gauze or a clean towel and follow the contact advice as given above. If you notice a split in the line If your line splits this is most likely to occur at the end near the bung. You may notice fluid under the dressing when your line is flushed. If you are receiving chemotherapy at home through an infusor bottle you may notice a white powdery substance under your dressing. If you think your line has split, contact the hospital where you are receiving treatment straight away for advice. If the line splits it can sometimes be repaired, but it may have to be removed. To avoid accidentally cutting your line never use scissors to help remove the dressing. page 12 of 16
Other common questions Can I have a bath or shower? It is important to keep your PICC dry when you have a bath or shower. You will have been given a long plastic glove for this when your line was inserted. Some people prefer to buy a special sleeve to keep the line dry; you can ask the person inserting your line for details of how to purchase these. If your dressing becomes wet it should be changed at the earliest opportunity. Can I continue with my everyday activities? There is no reason why you should not continue with your normal everyday activities such as work, exercise and sex. However, because of the risks of infection and dislodging your line you are advised not to: Go swimming Play contact sports, for example rugby or squash Lift weights or do heavy manual work What care does my PICC need? To reduce the risk of infection or line blockage, it is important that your PICC is cared for correctly. It is important that: the dressing covering your PICC is changed once a week or if it is soiled or loose the line is flushed once a week to make sure it is still working page 13 of 16
Who will look after my line? In some cases a district nurse may be asked to visit on the day after your line is inserted to change the dressing and flush the line. The district nurse may also be asked to do the weekly dressing change and to flush the line. If you are having some of your chemotherapy at home via an infusor bottle, you must have a relative or friend who is able to learn how to care for your PICC line. This involves disconnection of your bottle once chemotherapy has been given, flushing and dressing of your line. The nurses on the unit where you are being treated will be able to show your relative / friend how to do this. Your relative / friend will need to attend the hospital with you when the bottle is due to be disconnected to be shown how to do this. There are several benefits of having a relative or friend who is able to care for your PICC. It can reduce the risk of developing an infection in your line, and will also mean that you do not need to wait at home for the district nurse to visit. Where do I get more supplies of equipment? The hospital will provide you with a supply of equipment to cover the first 2 weeks after the line is inserted. You can get further supplies from your district nurse or GP. If your relative or friend is caring for your line you will need to obtain the equipment required each time you visit the hospital. page 14 of 16
Daily checks for all patients In order to prevent problems with your PICC, or to spot them early if they happen, it is important to do the following checks every day: Check that the dressing over the exit site is clean and dry, and that the exit site looks healthy (that there is no pain, redness, warmth or oozing around the site). Make sure the bung is securely attached. page 15 of 16
Useful contact numbers Weston Park Hospital 0114 226 5000 Ask for nurse practitioner Central Line Care Sisters 0114 226 5000 ask for bleep 3207 Ward O1 - Royal Hallamshire Hospital 0114 226 1149 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD5115-PIL1678 v3 Issue Date: February 2018. Review Date: February 2021