PICC Insertion

PICC Insertion

A peripherally inserted central catheter (PICC) is a form of IV access that allows medicines and IV fluids to be quickly distributed throughout the body. The PICC is a thin, flexible tube (catheter) that is inserted into a vein in your arm or leg. The PICC is guided through your veins until the tip sits in a large vein just outside your heart (superior vena cava or SVC). After the PICC is inserted, a chest X-ray may be done to make sure that it is in the correct place.

Only a health care provider trained in PICC insertion will do the procedure.

You may have a PICC placed:

  • To give medicines and nutrition.
  • To rapidly give fluids or blood products.
  • To take frequent blood samples.
  • If there is a problem placing a peripheral intravenous (PIV) catheter.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Bleeding. This may happen at the insertion site or internally.
  • Infection. This may occur at the insertion site or in the blood.
  • Movement or malposition of the PICC.
  • Inflammation of the vein (phlebitis).
  • Nerve injury or irritation.
  • Clot formation at the tip of the PICC line.
  • Blood clot in the lung (pulmonary embolus).
  • Injury or collapse of the lung (pneumothorax).
  • Injury to the large blood vessels or the heart. This is rare.

What happens before the procedure?

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • You may have blood tests. These tests can help tell how well your blood clots.
  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
  • Follow instructions from your health care provider about eating or drinking restrictions.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • Your health care provider will identify a vein into which the PICC line will be inserted. This may be done using ultrasound or X-ray guidance (fluoroscopy).
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
  • A tourniquet will be placed on your arm.
  • A small needle will be inserted into the vein and then a small guidewire will be advanced into the SVC.
  • The catheter will be advanced over the guidewire and moved into position. The guidewire will be removed.
  • The catheter will be flushed and blood will be drawn back to make sure it is in the vein.
  • If this was done without X-ray guidance, an X-ray will be needed to make sure that the catheter tip is in the correct position.
  • Once the placement is confirmed, the PICC will be secured to the skin. This may be done with a device, such as tape, or sutures (stitches).
  • A bandage (dressing) will be placed over the PICC insertion site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • You will be told how to care for your PICC line.
  • Do not drive for 24 hours if you were given a sedative.
  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.

Summary

  • A peripherally inserted central catheter (PICC) is a form of IV access that allows medicines and IV fluids to be quickly distributed throughout the body.
  • The PICC is a long, thin, flexible tube that is inserted into a vein in your arm or leg and then guided to a large vein (SVC) in your chest.
  • You will be instructed on how to care for your PICC line.

PICC Insertion, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After your procedure, it is common to have mild discomfort at the insertion site.

Follow these instructions at home:

Activity

  • Rest as told by your health care provider. Ask your health care provider when you can return to your normal activities.
  • If your PICC is near or at the bend of your elbow, avoid activity with repeated motion at the elbow.
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
  • Avoid using a crutch with the arm on the same side as your PICC. You may need to use a walker.
  • Avoid any activity that requires great effort as told by your health care provider.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • Keep the bandage (dressing) dry until your health care provider says it can be removed.

General instructions

  • Do not drive for 24 hours if you were given a medicine to help you relax (sedative).
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have a fever or chills.
  • You have more redness, swelling, or pain around the insertion site.
  • You have fluid or blood coming from the insertion site.
  • Your insertion site feels warm to the touch.
  • You have pus or a bad smell coming from the insertion site.
  • Your vein feels hard and raised like a “cord” under the skin around the insertion site.

Get help right away if:

  • You have swelling in the arm in which the PICC was inserted.
  • You have numbness or tingling in your fingers, hand, or arm.
  • You have a red streak going up your arm from where the PICC was inserted.
  • Your PICC cannot be flushed, is hard to flush, or leaks around the insertion site when flushed.
  • You have pain in your arm, ear, face, or teeth.
  • Your PICC is accidentally pulled all the way out. If this happens, cover the insertion site with a bandage or gauze dressing. Do not throw the PICC away. Your health care provider will need to check it.
  • Your PICC was tugged or pulled and has partially come out. Do not push the PICC back in.
  • You hear a “flushing” sound when the PICC is flushed.
  • You feel your heart racing or skipping beats.
  • There is a hole or tear in the PICC.
  • You have pain in your chest.
  • You have shortness of breath or difficulty breathing.

Summary

  • After your procedure, it is common to have mild discomfort at the insertion site.
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
  • Flush the PICC as told by your health care provider. Let your health care provider know right away if the PICC is hard to flush or does not flush. Do not use force to flush the PICC.
  • Check your insertion site every day for signs of infection.
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