Some illnesses require long-term, intravenous (IV) medication. A PICC line is a reliable method for administering fluids, nourishment, or treatments. Unlike a standard IV, it stays in place for weeks or even months. Although similar to a standard IV in some ways, a PICC line has specific procedures and requirements in order to prevent infection. PICC lines are easier on patients, especially those diagnosed with a serious illness or chronic condition who require repeated IV draws for blood analysis, IV medications, or fluid replacements.

PICC Line Specifics

A peripherally inserted central catheter or PICC line is a long, flexible catheter tube with a guide wire inside. For most patients, a medical professional inserts one end of the PICC line into the arm and threads it through a vein, into a larger vein in the chest. The other end of the PICC line consists of one to three lumens with caps. These lumens connect the PICC line to the IV bag of fluids or medications.

Preparing the PICC Site

In order to choose a vein, specialists analyze the blood vessels in the arm and upper chest to find a vein that can adequately support a PICC line. Depending on the hospital or medical facility, the procedure may be performed in a radiology department. Preventing infection is crucial. A specially trained member of the medical team establishes a sterile field, draping the patient with a sterile cloth. The person inserting the line sterilizes the area of the arm with a cleansing solution to clean off any bacteria existing on the skin. Before inserting the PICC line, the medical professional numbs the site.

PICC Line Sites

In most cases, adults have the PICC line inserted in their arm, just above the elbow. However, for children, other sites such as the neck or leg may be chosen. Lymph node dissection sites, blocked blood vessels, burns, or extensive scar tissue on the arm are not suitable places for a PICC line. Additionally, some procedures such as shoulder surgery, vascular surgery, pacemakers, or radiation treatments may require doctors to place the PICC line in a different site.

PICC Line Insertion

The length of the PICC line may be shortened if the patient is smaller in size. Once the chosen site for PICC line insertion is numb, doctors make a small incision to allow access to the blood vessel. The PICC line is slowly and gently threaded through the vessel, towards the heart. When the line reaches the larger chest vein, the line is secured. Instead of relying on tape to hold the PICC line in place, the tubing and port may be sutured at the insertion site. The guide wire is removed once the line is secured.

Additional Reasons for PICC Lines

PICC lines cut down on patient discomfort and allow for long-term treatments outside of a hospital setting. Standard IVs should only be left in the arm for a limited period. PICC lines last for up to 12 months as long as the site remains free from infection. Dehydration and fragile blood vessels present a challenge when providing treatment of serious diseases. Administering medications in a standard way is not always possible. PICC lines allow the administration of medications, such as chemotherapy drugs, that are damaging to the skin not only around the IV site but within the vessel itself. With PICC lines, more than one medication may be administered at a time without mixing them.

PICC Line vs a Central Venous Access Line

Sometimes, an emergency or surgical procedure requires a central line instead of a PICC line. A central venous access line is used as a result of excessive blood loss. Instead of accessing the blood vessel through a site on the arm, the doctor makes an incision near the collarbone and threads the central venous access line through the vessel into the larger vein above the heart. However, a central line can restrict daily activities and the supplies required to maintain it cost more. In many cases, a PICC line is considered safer.

PICC Line Risks

PICC line insertions occasionally allow an air embolism to enter the vessel, so proper flushing techniques should be followed to remove any air in the line before the procedure. Bacteria living on the skin around the line at the entry point cause infection at the site, or they enter the bloodstream, which could lead to sepsis. The longer the PICC line is in place, the more likely infection could occur. Occasionally, the PICC line may clog, but medications can usually clear it up.

PICC Line Care

Regular dressing changes around the insertion point are important in order to reduce the chance of infection. Wet or dirty dressing should be changed immediately. Before touching the PICC line or performing maintenance, handwashing is crucial. Keep the PICC line site dry. Apply a waterproof bandage before bathing, showering, or swimming, and never allow the arm to be submerged in water. Lines should be flushed at least every 24 hours, or after an infusion of medications, nutrients, or other fluids.

Signs of Infection

A fever of over 100 degrees or higher could mean there is an infection in the body. Redness, pain, or inflammation around the site indicates infection. A burning sensation in the shoulder, chest, back, or arm, could also indicate infection. However, shoulder or chest pain could indicate heart irritation caused by the PICC line being too close to the heart. Occasionally, the site will begin to ooze, or the individual experiences muscle stiffness and difficulty with movement. These could also be signs of infection, and the individual should seek medical attention.

Blood Clots

Using ultrasound, medical personnel see a close-up view of the blood vessels allowing them to decide which ones are large enough to accommodate the PICC line. Vein diameter is important. There must be enough space around the line to allow for blood flow. If there isn’t, blood clots form. Should they break loose, clots can travel in the bloodstream to the lungs and interfere with blood supply. If a clot forms at the insertion site, both the PICC line and the clot must be removed. It can take months before professionals consider it safe to insert the PICC line again. Shortness of breath or an irregular heartbeat are indications of a possible clot.