PICC LINES

So, you've been told you'll be having a PICC Line inserted. What does it mean? What will it do? How does it work? All sorts of questions, and hopefully, here are some of the answers for you.

A PICC is a long, flexible tube that is put into a vein in your arm and threaded up into a large vein just above your heart. It is used for giving fluids or drug treatment into your bloodstream. PICC stands for "Peripherally Inserted Central Catheter".

So now you can learn all about PICC lines, the Hickman line section will be following on later....

All about PICC's
How and where is the PICC put in?
Problems with the PICC insertion
What aftercare will I need?
What can go wrong with PICC's?

All About PICC's
A PICC works on the same principle as a "drip" but it can stay in for much longer - sometimes several months. The end of your PICC sits in a large vein just above your heart so there is plenty of blood rushing past it to dilute the drugs and take them safely into your bloodstream.

A PICC allows us to give you repeated or continuous treatments without having to keep finding a vein. You can go home with the PICC in, and usually blood samples can be taken from it without having to use a needle each time.

Some PICC's have just one line or "lumen" while others have two - a bit like a road tunnel with two lanes. This allows us to give more than one drug at once or to take blood while fluids are running. The nurse looking after you should be able to tell you what type of PICC you will have. Ask him or her to show you a PICC so you have a clear idea of what to expect.

How and where is the PICC put in?
The PICC can be put in by a specially trained nurse in the outpatient department or on the ward. You can eat and drink normally beforehand.

Allow four to five hours for the appointment but it usually only takes a few minutes to actually put the line in. First we will apply cream to a patch of skin on your arm to numb it. Once the skin is numb (which takes about 60 minutes) a needle is used to place the PICC in your vein.

This should be no more painful than having a routine blood test. The needle only stays in for a few seconds and once it has been removed the PICC is then threaded up into a large vein above your heart. You won't feel this, except for a slight pushing sensation.

Once the PICC is in place it will be covered with a transparent dressing and you will be asked to have a chest x-ray to check the position of the line. Once the position has been checked, the PICC is ready to use. If you are an outpatient you may be asked to come back to the hospital the next day for the dressing to be changed.

Problems with the PICC insertion
Most PICC insertions go smoothly, but sometimes we encounter problems.

Sometimes a patient's veins are small which makes it difficult to put a PICC in.
Sometimes, the shape of the veins prevents the PICC from being threaded up towards the heart. If this happens we will often try again using a different vein and this usually works.
Sometimes the PICC seems to go in well but the x-ray shows it is in the wrong position. In this case we will often take it out and try another vein.

If your PICC insertion is unsuccessful, we will probably suggest an alternative such as tunnelled line (sometimes called a "Hickman Line".

What aftercare will I need?
When it is not being used the PICC will need to be flushed once a week to stop it from getting blocked. The dressing will also need to be changed once a week.

It isn't easy to look after your own PICC because you would have to learn to change the dressing and flush the line with one hand!

Some patients have managed this but most people have help from nurses in the hospital and at home. Some patients lines are flushed and cleaned by their partner, a member of their family or a close friend.

Don't worry if this isn't possible: your hospital can usually arrange for a district nurse to flush and clean the line.

If a relative, partner or friend is going to help look after the PICC, the earlier they start, the better. We will aim to start teaching them (or you!!) how to flush and clean your line before it is even put in, and if not, immediately afterwards. This does not mean that they will have to do it on their own straight away. We will always try to take things at their pace so that they feel confident about what they are doing.

What can go wrong with PICC's?
Most patients go through their treatment without having any problems with their PICC, but there are certain risks involved. It's very important for you to know what can go wrong so that you can help prevent problems or deal with them if they happen.

BLEEDING: Many patients experience minor bleeding around the entry site just after the PICC has been put in, and this usually stops after a few hours and causes no problems. The risk of bleeding is increased if you have problems with the clotting mechanisms in your blood. If you have a history of any abnormal bleeding or if you are taking any medicines which may affect the blood please ensure that you inform the person putting in your PICC.
PHLEBITIS: Although a PICC is a very fine tube, it can sometimes irritate the inside of the vein wall in your arm during the first few days. To prevent this we will ask you to use a warm compress (e.g. a lukewarm hot water bottle) on the arm for 10 minutes four times a day for a few days after the PICC is put in. If despite this you still develop phlebitis, contact us for advice.
INFECTION: This can be a problem, particularly for patients who have a decreased resistance to infection. We take every precaution to reduce the risk of infection: we take great care when putting the PICC in and when cleaning and flushing the line. But despite this, infections can happen at any stage.

Often we treat an infection with antibiotics, but sometimes we will need to remove the PICC to prevent the infection from getting worse and causing serious blood poisoning.
FAILURE TO BLEED BACK: A PICC is designed to allow us to take blood samples, but sometimes blood cannot be withdrawn. We can usually solve the problem by putting a special flush down the tube, but occasionally this fails, especially if the tip of the PICC is resting against the wall of the vein, stopping blood from being drawn back into the line.

This is not a serious complication but it can be disappointing - nobody likes having blood tests taken with a needle. If this happens to you we will do all we can to get the line bleeding again.
THROMBOSIS OR CLOTTING: Having a PICC sitting in a vein does mean there is a risk of causing a blood clot. Depending on your diagnosis, we sometimes prescribe a course of tablets to reduce the likelihood of a clot. If you do develop a clot, we will usually remove the PICC and then administer medication to dissolve the clot.
SPLIT LINE: It is very important to prevent the PICC from getting damaged - for example, you should never use scissors near it! In the very unlikely event of the PICC developing a split or a break, we will usually remove it, although occasionally it is possible to carry out a repair using special equipment.

Further Information
If you have any questions about PICC's please don't hesitate to ask your nurse or doctor.