Patient education: Peripherally inserted central catheter (PICC) insertion (The Basics)

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

You might need a PICC if you:

●Need to get medicines or fluids for a few weeks or months

●Are taking medicines that need to be given through an IV, and the surface veins in your arm are very hard to find

●Need to take medicines that would irritate small veins

With a PICC, you can get the nutrients, fluids, blood, and medicines you need. 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.

How is a PICC different from a simple IV? — A simple IV only goes a little way into a surface blood vessel. Most simple IVs last only for a few days.

A PICC is a long, thin, flexible tube called a "catheter." A doctor or nurse places the PICC in a vein located more deeply in your upper arm. They will move it forward until the tip or end of the catheter is in a larger vein near your heart (figure 1). A PICC can stay in place for weeks or months.

A PICC can also have 1, 2, or 3 ends called "lumens" or "hubs." These stay outside of the body and are covered with caps. Some PICCs have a clamp on the outside, and others have valves inside of them. You can go home from the hospital with a PICC.

How do I prepare for a PICC? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. Ask the doctor or nurse if you have questions or if there is anything you do not understand.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding or clotting problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●If you are not able to have medicines that make your skin numb – These types of medicines are used when you have stitches or dental work (sample brand names: Lidocaine, Xylocaine, Novocain).

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time. Whether you need to fast, and for how long, depends on if you will need medicines to help you relax during the procedure.

●Lowering the risk of infection – Sometimes, the doctor or nurse might need to trim (not shave) your body hair before your procedure. They might also have you wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or help you care for the PICC at home.

What happens during a PICC placement? — When it is time for the procedure:

●You might be in your hospital room or in a treatment room. The doctor or nurse might give you medicine to help you relax.

●You will lay your arm on a table or pillow.

●The doctor or nurse will clean your arm with a special soap. They will also cover your arm and body with sterile towels and sheets. They will wear a face mask, hat, gown, and gloves to help prevent infection.

●The doctor or nurse might give you a local anesthetic. This is a medicine to numb a small part of your body so you don't feel pain.

●They might use an ultrasound machine to guide the PICC into your vein. An ultrasound is an imaging test that creates picture of the inside of your body. The doctor or nurse will put the PICC into a vein in your arm and slide it into position in a large vein near your heart.

●When the procedure is done, the doctor or nurse will "flush" the PICC with a sterile fluid. Then, they will place a cap on each of the lumens.

●In some cases, doctors will place a:

•Small sponge disc that will help prevent infection

•Device to help hold the catheter in place

●They will place a clear dressing over the area (figure 2).

●The procedure takes 30 to 60 minutes.

What happens after the PICC is placed? — The doctor or nurse will make sure that the PICC is in the right place before it is used. In most cases, they will check this by doing a chest X-ray. They can also use a special type of "ECG" technology to make sure that the PICC is in the right place.

If you are in the hospital, having a PICC will not make your stay longer.

What are the risks of having a PICC? — The doctor or nurse will talk to you about all of the possible risks and answer your questions. Possible risks include:

●Infection

●Irritation of the vein (called "phlebitis")

●Blood clot in the vein (called "vein thrombosis")

●Blood clot in the lung (called "pulmonary embolism")

●Bleeding

●The PICC stops working, breaks, or leaks

●The tip of the PICC moves out of place

●A collapsed lung (called "pneumothorax")

What else should I know? — If you are going home with a PICC, you might need a family member or friend to help you care for it. Some people have a home health nurse come to their home to help with this.

More on this topic

Patient education: How to care for a peripherally inserted central catheter (PICC) (The Basics)
Patient education: Peripherally inserted central catheter (PICC) removal (The Basics)
Patient education: Central line infections (The Basics)