Patient education: How to care for a peripherally inserted central catheter (PICC) (The Basics)

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What is a peripherally inserted central catheter? — A peripherally inserted central catheter, or "PICC," is a special kind of IV (figure 1). It is also called a "PICC line."

With a PICC, you can get the nutrients, fluids, blood, and medicines you need directly into your body. The medical staff might be able to draw blood for lab tests through your PICC. When you have a PICC, you might also need fewer needle sticks for IVs or blood tests.

A PICC can stay in place for weeks or months. A PICC can have 1, 2, or 3 ends called "lumens." These stay outside of the body and are covered with caps. Some PICCs have a clamp on the outside that closes off the line. Others have a valve inside that acts as a clamp. You can go home from the hospital with a PICC.

How do I care for a PICC? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

You should also:

●Know what kind of PICC you have and how to care for it. Before you go home, your doctor or nurse will talk to you about this. They will teach you how to change the dressing, flush the PICC, and change the caps. They will also make sure that you have the supplies you need. Having a PICC increases your risk of infection. This is why it's so important to take care of it.

●Ask a family member or friend to help you care for the PICC, if needed. Some people have a home health nurse come to their home to help with this.

●Keep the PICC covered at all times with a dressing. Keep the dressing clean and dry.

How do I change the dressing on the PICC? — To help prevent infection, keep your skin clean and change the dressing regularly. Replace clear dressings every 7 days. Always change the dressing right away if it is wet, loose, or dirty. It is easier if another person helps you change the dressing.

●Gather the supplies, and place them on a clean workspace. You need sterile gloves, chlorhexidine swab sticks, and sterile dressings.

●Everyone should wash their hands well with soap and water before touching the PICC. This will help to avoid spreading germs.

●Wear a mask when you change the dressing. If another person is helping with the dressing change, they should wear a mask as well.

●Wear clean gloves, and take off the old dressing. Do not use scissors or sharp tools. They could cut the PICC. Hold the PICC in place when taking off the dressing.

●Check the skin where the PICC enters for swelling, drainage, or redness.

●Wash your hands again. Put on sterile gloves.

●Clean the skin with a chlorhexidine swab using a back-and-forth motion for 30 seconds. Starting where the PICC enters the skin, clean the PICC and the skin, moving outward. Clean the entire area that will be under the dressing, about a 4-inch (10 cm) square. Let air dry for at least 30 seconds.

●In some cases, doctors will give you:

•A small sponge disc to help prevent infection – If you have this, put it around the PICC where it comes out of the skin. The colored side should be facing away from the skin.

•A device to help hold the PICC in place – If you have this, remove the adhesive cover and stick it to the skin under the hub of the PICC. Place the hub on top of it, and close the clasp or patch.

●Use a clear dressing that sticks to the small sponge disc, any devices used to hold the PICC in place, and any of the tubing outside of the vein (figure 2). If the tubing is long, gently curve it away from where the IV goes into the skin before putting the dressing on. The tubing should not cover the spot where the PICC enters the skin, and it shouldn't be coiled on itself.

●Do not pull on the dressing while applying, as it will pull on the skin. Gently press around the edges of the dressing to help them stick to the skin. Use medical tape around the edges if the dressing is not sticking.

●Throw away the old dressing and used swabs and wipes.

●Remove the gloves.

●Wash your hands with soap and water.

How do I flush the PICC? — Flush all of the lumens of the PICC each day with a sterile fluid. You should also flush a lumen after it is used to give medicine. This helps keep the PICC from getting blocked. Your doctor will order heparin, normal saline, or another solution for you to use.

●Gather your supplies, and place them on a clean workspace. You need alcohol wipes and a syringe filled with the fluid to flush the PICC. Your doctor or nurse will tell you the right amount of fluid to use. You need these supplies for each lumen you need to flush.

●Wash your hands with soap and water.

●Scrub the cap for at least 15 seconds with an alcohol wipe on the top and sides. Let dry.

●Remove the end cap from the syringe, and check for air bubbles. Slowly push the syringe plunger forward until all of the air is out of the syringe.

●Screw the syringe onto the end of the cap on the PICC.

●Unclamp the PICC (if you have a clamp). You might be told to gently pull back, or "aspirate," until you see blood in the PICC. Then, push the fluid into the PICC. The doctor or nurse will tell you which method of flushing is best for the PICC you have. They might tell you to:

•Flush slowly and steadily until the syringe is empty, then clamp (if the PICC has a clamp).

•Flush slowly until the syringe is at the 7-mL mark, then pause for a second. Next, flush slowly until the syringe is at the 4-mL mark, then pause for a second. Finally, flush slowly to the 1-mL mark. As you reach the 1-mL mark, hold pressure on the syringe and clamp the PICC before you get to the very bottom of the syringe. This example is using 10 mL of flush. The amount you give might be different.

●Remove the syringe from the PICC.

●If your PICC does not have a clamp, or you were told not to clamp the line, remove the syringe just before the black stopper reaches the bottom of the syringe.

●Repeat these steps for each lumen of the PICC. Use new supplies for each lumen. Do not reuse the same syringe.

●Throw out any used swabs, wipes, or other supplies. Throw away syringes in a hard plastic container (picture 1).

●Wash your hands with soap and water.

How do I change the cap? — The cap is used to connect syringes or tubing to the PICC. The cap might also be called a "needleless connector" or an "injection cap." Change the cap on each lumen every 7 days, or anytime there is a leak. A good way to remember this is to change the caps each time you change the dressing.

●Gather your supplies, and place them on a clean workspace. You need alcohol wipes, a sterile cap, and a syringe of fluid for each lumen of the PICC.

●Wash your hands with soap and water.

●Remove the new cap from the package without touching the ends.

●Connect the syringe of fluid to the end of the new cap. Hold the syringe so the cap points up, and "prime" the cap with the fluid. To do this, tap the cap gently to get rid of any air bubbles and leave the syringe joined to the cap. Set the cap down on a clean alcohol wipe.

●Clamp the PICC (if it has a clamp), and remove the old cap.

●Scrub the lumen of the PICC for at least 15 seconds with alcohol. Let air dry.

●Remove the sterile tip protector from the new cap.

●Screw the new cap onto the PICC. Unclamp the PICC, and flush it as instructed. Clamp the PICC. Then, remove the syringe from the cap.

●Throw out any used swabs, wipes, or materials.

●Wash your hands with soap and water.

What else should I know? — While your PICC is in, you should:

●Avoid contact sports or rough play.

●Keep sharp objects away from the PICC.

●Avoid swimming or soaking in water.

●Keep the dressing covered when showering. Change the dressing if it gets wet, dirty, or loose.

●Make sure that the PICC is secured with special PICC holders or tape.

●Make sure that the caps are secure, and the clamps are closed, when you are not using the PICC.

●If the PICC has a clamp, keep it clamped when the lumen is exposed to air. For example, it should be clamped when connecting to fluids or when changing the cap. The doctor or nurse will teach you when and how to clamp the PICC correctly.

●Check every day for signs of infection.

When should I call the doctor? — Call for advice if:

●You have symptoms of an infection. These include a fever of 100.4°F (38°C) or higher, chills, or redness, drainage, warmth, stinging, or pain where the PICC goes into the skin.

●There are problems with the PICC, like:

•The PICC falls out all of the way or part of the way.

•The tubing breaks, cracks, or leaks.

•You cannot get the medicine or flush solution through the PICC.

•You cannot get a blood return from the PICC.

•You have any concerns about the PICC.

●You have sudden shortness of breath or chest pain.

●You have pain, tenderness, firmness, or redness along the vein where the PICC is located.

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Patient education: How to care for a peripherally inserted central catheter (PICC) (The Basics)