Procedure and care of a Peripherally Inserted Central Venous Catheter (PICC)

What is a PICC?

A PICC line is a long narrow flexible tube inserted into a vein in the upper arm. The PICC is then threaded along the vein so that the tip lies in one of the large veins in the chest. The length of the line is dependent on how tall you are and where the line is inserted (left or right sided). Usually, it is 40 to 55 cm long. A specially trained nurse or doctor will insert your PICC.

You will be assessed by a member of the medical team before a PICC is inserted as it is not suitable for all patients.

What are the benefits of having a PICC line?

A PICC line can be used to allow different medications, fluids, nutrition and antibiotics to be given intravenously (directly into a vein) and allows for any intensive treatment to be started immediately.

A PICC line can also be used for:

• Chemotherapy or other medications that can irritate smaller veins.
• Intravenous feeding.
• Giving blood and blood products such as platelets.
• Taking blood samples.

A PICC line is an ideal option for people:

• with small veins.
• who have a fear of needles.
• who are unable to have a different type of line because they are taking blood thinning medication.
• who are unable to lie flat.

How will the PICC be put in?

We will need to place a tight band called a tourniquet around your upper arm; this will make your veins larger. We will then use ultrasound to scan your arm to make sure that the vein is suitable.

The doctor or specialist nurse will clean your arm and cover it with a large sterile drape. Local anaesthetic will be injected into the arm to numb the area. Once the area is numb the PICC will be inserted. The procedure usually takes about 30 minutes.

Occasionally, it may be difficult to thread a PICC line and we may ask you to change your position slightly to make this easier. Most people do not find the procedure painful or uncomfortable; in fact, most patients find it less painful than a blood test!

After your PICC is inserted, you may need to have a chest X-ray to confirm that the line is in the correct position. However, most lines are now inserted under ECG guidance, which is a more accurate way of confirming that the line is in the correct place.

What happens after the procedure?

Once the local anaesthetic wears off, you may feel some slight discomfort or an aching feeling in the arm where the PICC has been inserted, this is common. If needed, pain relief can be given to help with any discomfort, please speak to the nurse looking after you.

You may have some bruising around the area where the PICC was inserted. You may also notice some blood on the dressing; this is normal and nothing to worry about.

In some cases, there may be some tenderness and swelling around the insertion site, especially during the first week after the PICC has been inserted. Please make sure that you continue to move your arm as normal.

If the pain and swelling persist, you should speak to the nurse looking after you. If you are at home, you can contact your GP/practice nurse for advice.

What are the risks of PICC insertion?

As with most procedures there is a small risk of complications which may include:

• Infection – there is a small risk of infection after having a PICC inserted.
• Correct line placement - the catheter tip in the vein may not be in the correct position and sometimes needs to be adjusted.
• Bleeding and some bruising around the insertion site, especially in people whose blood does not clot normally.
• Accidental puncture of the artery which may cause bleeding.
• Nerve damage is rare, however, during the procedure you may feel a shooting pain down your arm if the needle touches a nerve.
• Thrombosis (blood clot), there is a small chance that a clot will form in one of the smaller blood vessels in the arm. If you notice any areas that are swollen, painful and hot to touch, please speak to your care provider.

What routine care will my PICC need?

If you are an inpatient, the ward nurses will look after your line. If you are an outpatient, either the district nurses or the IV therapy team will care for your line. Your PICC line may need to be redressed 24 hours after it is inserted. If we have used catheter securement adhesive, it will be 7 days. We will specify this to you after the catheter has been inserted.

From then on, your PICC line will need to be redressed once a week. If your PICC line is not being used continually for treatment, it will also need to be flushed once a week. This will be done at the same time as the dressing change.

It may be possible to arrange to have these things done by a district nurse, at your GP practice or at a hospital more local to you when you do not have other appointments. Nursing staff will discuss this with you.

If the PICC line is cared for appropriately it can remain in place for up to 6 months.

We will explain everything carefully to you before you have your PICC line inserted and will answer any questions you may have.

Frequently asked questions

Can I eat and drink before having my PICC inserted?

We recommend that you only have a light meal before having your PICC inserted. Please make sure you are well hydrated.

Can I have a bath/shower or go swimming?

As a rule, we encourage people with PICCs to take a shower rather than a bath because of the risk of infection if the PICC is submerged in bathwater.

When showering it is important to keep the PICC line dry. There are several shower sleeves available online or in the high-street pharmacies.

How is the PICC line removed?

PICC lines are easily removed. A nurse will remove the dressing and gently pull the line out. Pressure will be applied for a few minutes to prevent any bleeding. A small dressing will be placed over the site. There should not be any bleeding or pain. The wound will heal naturally.

Care must be taken when washing and dressing as the wound must be kept dry during healing.

How else can I help in caring for my PICC?

It is important to remember that this is your PICC, and you are entitled to insist that anyone accessing or caring for your line does so properly.

Contact information

If you have any concerns, please contact the IV therapy team or your GP’s practice. If further intervention is needed, they will be able to contact the Vascular Access Team at Gloucestershire Hospitals NHS Foundation Trust.