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PICC Line 101

Posted Feb 11 2013 4:48pm

PICC stands for “peripherally inserted central catheter.” It is a long tube inserted into the arm and used for intravenous antibiotic therapy.. The tubing that goes into the arm is threaded into a very large vein, which connects it to the right side of the heart. By delivering medication so close to the heart and also gets diluted as to not irratate the veins.

PICC Line Placement and what to expect? 

The process of inserting a PICC line is as follows:

1. The length of the PICC to be inserted is determined by measuring the distance from the crook of the elbow to the heart.
2. A trained medical professional will clean and prep the site (normally side of upper arm)
3. You will probably receive local anesthesia by injection. After this point you shouldn’t feel anything other than slight pressure from the dr pushing on your arm.
4. A small needle is inserted into a large vein in the inside of the site.
5. A wire is placed through the needle, then the needle is removed. A special tube called an “introducer sheath” is placed over the wire. This makes sure that the puncture in the arm is large enough for the PICC line.
5. The PICC line and introducer sheath are fed into the appropriate vein over the wire. Threading stops when the total length inserted matches the length that was measured at the beginning. Heart rate monitors are also used to make sure the PICC is in the right place.
6. The introducer sheath and wire are removed.
7. The line is capped. To verify that the line is in the vein, it is flushed with normal saline. The syringe is then used to check for blood return.
8. A chest x-ray is done to confirm that the line is placed in the correct position. (This is not always the case as now there are new ways via monitors for them to check position of the PICC)
9. The line is flushed with heparin, to prevent clotting in the line. (This depends on hospital or patient center. I flush with heparin but not all people do.)

The arm that the PICC line is put in will probably be sore for a day or two but that pain should go away as your veins get used to the foreign object in your system. Plus you just had a tube put in your arm… It’s going to hurt a little. However, during the placement you shouldn’t have any pain.
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PICC Line Chic: My favorite part 

Co-Flex (A cohesive flexible bandage) is available in pretty much any color or design. Co-Flex bandages are good to use when you won’t be accessing the PICC for a period of time. For example: If I only do my infusions in the morning and night I will wrap a Co-Flex bandage around during the day. I like how they don’t fall off or roll up. They also are good for wearing tighter long sleeve shirts because they aren’t balky. Really I just like to match them to my outfits….
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Another option for a PICC line cover is to take a tube sock and cut off the end. This can also be whatever color you want and is nice because you can get soft sock (I like fuzzy things). I use the sock mostly when I am doing lots of infusions at once or I know I will be using my PICC line alot that day because it is super easy to take on and off where as with Co-Flex you use a strip once and than you have to cut another strip (not ideal when using a lot). Downside to the sock is that it is a little bigger and sometimes the ends will roll up. It doesn’t stay in place as well under shirts and stuff.
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PICC Line Care: Changing the dressing 

I would recommend always having someone help you change the dressing for your PICC line because although it is possible to change it on your own its difficult since you really can only use one hand. So having someone help you makes it easier and quicker. A nurse or home health care specialist will demonstrate the proper care of dressing changing and have you demonstrate for her before sending you home to do it yourself. A nurse or home care specialist will demonstrate how to do the changing properly and probably make you do one while they are there if you are expected to do it on your own. Keep in mind that the first and second dressing changes might irritate your arm and you might be sore but after a few changes it gets better! I change my PICC dressing 1-2 times a week. My home care policy says I only need to change it once a week but sometimes if there is a little puss (t0p left picture) or if my skin is irritated I like to change it an extra time to make sure it doesn’t get infected and for my own comfort. Always wear gloves and preform the dressing change on a clean surface. My home care provides me with a steril sheet to put down under my arm but we always wipe down the table too. Home care or hospital should provide you with dressing change kits. I also recommend asking for a bio patch – its the little circle thing covering where the PICC enters (top right picture below). These aren’t necessary but they are just extra protection against infection and I also like them because than I don’t have to look at where the tube enters my skin. Screen Shot 2013-02-10 at 10.20.55 PM

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