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Peripherally inserted central catheter (PICC)

What is a PICC?

A PICC is a thin, flexible tube that is inserted into a vein in the upper arm. The PICC is threaded along the vein in your arm until the tip sits in a large vein near the centre of your chest, the other end is securely fixed to your arm. It is designed to administer medications, fluids, blood products, and to take blood samples through.

The line is kept in place with a dressing and with a securing device. The securing device is either an adhesive securing device that sticks to your arm, or a special device with flexible securing feet that sit beneath the skin holding the line in place.

You can go home with the PICC in, and it can be left in for weeks or months.

The PICC line may have one or two lumens and it may be suitable for intravenous contrast during CT scans (power PICC) – the exact type will depend on the type of treatment you require.

How is the PICC put in?

You will have your PICC inserted in the operating theatre under local anaesthetic. You may feel some stinging when the local anaesthetic goes in and some pushing and pulling during the procedure. There may some brief periods of discomfort.

The procedure usually takes about 15-30 minutes. First, the veins in your arm will be examined with an ultrasound machine to make sure they are suitable - you will have a tourniquet on your arm during this stage. Once a suitable vein is identified, I will clean your skin with antiseptic solution and numb the skin with local anaesthetic. I will then thread the PICC into the vein and check the position with an X-ray. The PICC will be held securely in place with glue and a dressing, you will not require any stitches. The dressing will need to be changed after a week but sooner if it becomes soiled or starts to peel off.

Possible problems when putting in the PICC

If your veins are small, it may be difficult to put the PICC in. Sometimes it can be difficult to thread the PICC up the vein towards the heart. If this happens, it is possible to try again using a different vein.

PICC

Care of your PICC line

When the line is not being used there is a slight risk that it may become blocked. To prevent this, a small amount of fluid is flushed into the line using a syringe; this is usually done once a week.

The dressing and bungs will need to be changed each week to reduce the risk of infection. As it is difficult to do this yourself with one hand, the nurses at the hospital may do it for you or arrange for a nurse to visit you at home. A partner, relative or friend can also be taught to do this if they feel happy to. An example of a dressed PICC is shown below.

dressed PICC

When you are showering, we recommend that you wrap your upper arm with cling film or use a waterproof sleeve to prevent the PICC from getting wet. You should not submerge the line or swim with a PICC in.

Gentle exercise is fine but avoid vigorous exercise that could damage or dislodge the line.

You should check that the bungs are secure and that the clamps (if present) are closed when the line is not in use – you should try to do this daily.

Using the PICC line

The end of the line must be thoroughly cleaned with an antiseptic (chlorhexidine) wipe before it is used.

Anyone using your line should be trained and should be using a special technique called an ‘aseptic non-touch technique.’ They should not be use a syringe smaller than a 10 ml syringe. Each lumen of your line needs flushing after use to prevent it from becoming blocked.

How the is PICC removed?

When you no longer need a PICC it will be taken out. A nurse will usually do this for you - it is a painless procedure that only takes a few seconds.