PICC Line Placement

PICC stands for "peripherally inserted central catheter." A PICC line placement is a minimally invasive procedure in which a thin, long, flexible tube called a catheter is inserted through a vein in your upper arm and passed through to a large vein near your heart.

Outside of the body, the PICC splits into 1, 2, or 3 smaller tubes called lumens. Each lumen has a needleless connector (also referred to as clave) and a disinfection cap on the end.

A PICC line is mostly used to provide medications and other treatments directly to the large central veins near your heart.

Indications

Your physician may recommend a PICC line placement if your treatment plan requires frequent needle sticks for intravenous (IV) therapy of any sort for a long period of time. A PICC line is typically meant to be temporary, and may be an option if your treatment is expected to last up to several weeks. In general, a PICC line is usually recommended for the following:

• Delivering chemotherapy and other IV medications, such as antibiotics
• Providing blood transfusions
• Providing IV fluids or liquid nutrition
• Obtaining blood samples

Preparation

Preparation for a PICC line placement may involve the following steps:

• A thorough history and physical examination
• Blood tests to ensure you have sufficient and healthy blood-clotting cells (platelets)
• Imaging tests, such as X-ray and ultrasound, to create pictures of your veins to plan the procedure
• Informing your doctor of any medications or supplements you are taking
• Informing your doctor of any recent illnesses or other medical conditions you have, such as a history of kidney disease
• Signing an informed consent form after the pros and cons of the procedure have been explained

Procedure

A PICC line is typically placed by a physician assistant or nurse at the bedside of an individual in a care facility or hospital on an inpatient or outpatient basis. The PICC line is a catheter with a guidewire inside. This stiffens the tube so that it is easier to thread into a vein.

In general, the PICC line placement procedure takes about an hour and involves the following steps:

• A vein is selected.
• A non-invasive imaging technique called ultrasound is utilized to locate the optimal site and guide the line placement.
• The insertion site is administered with a numbing agent, usually 1% lidocaine solution.
• After the site is cleaned, a small incision is made to access the vein.
• The line is gently threaded into the vessel and advanced toward the heart. You may feel a slight discomfort (an unusual pressure) but normally no pain.
• Once the line is placed, it is secured to the skin of the arm with stitches.
• Finally, an X-ray is taken to make sure the line is correctly positioned.

Post-procedure care

After the PICC line placement procedure, you will be monitored in an observation room until you are ready to be discharged home. You may experience mild discomfort, pain, or swelling, or notice some bleeding at the catheter exit site, which may last for a couple of days. If you notice any bleeding, apply pressure and a cold compress to the region. Do not lift anything heavy with the PICC line arm or do strenuous activity for about 2 weeks. Do not shower for 24 hours after your procedure. Instructions on incision site care and bathing will be provided to keep the wound and catheter site clean and dry.

Risks and Complications

Risks and complications associated with a PICC line placement may include:

• Infection
• Blood clots
• Bleeding
• Irregular heartbeat
• PICC line malfunction
• Phlebitis (vein inflammation)
• Nerve injury
• Allergic reaction

Benefits

Some of the benefits of having a PICC line include:

• Eliminates the need for frequent needle sticks to give medications or draw blood
• Spares your blood vessels and veins from the irritating effects of IV medications
• Can be utilized for numerous types of IV therapies
• Can be utilized to get most blood tests
• Can be used at home, a nursing facility, or a hospital setting, and can remain in place for weeks or months, if required

Summary

A PICC line helps to deliver medications, fluids, draw blood, or carry out blood transfusions more easily. Having a PICC line decreases the need for repeated needle sticks and can make your treatment more comfortable. A PICC line is for safe, long-term use, and can be easily removed when no longer needed.