Why do I need this procedure?
A Peripherally inserted central catheter (PICC) line can be used to allow medication, fluids, nutrition or antibiotics to be given intravenously (given directly to a vein). In addition, it can also be used to take blood samples, which reduces the need for multiple needle punctures in the arm.
A PICC line is a long narrow flexible tube inserted into one of the veins of the arm. The length of the line depends on how tall you are and where the insertion site is. Usually, it is 38–52cm long. It has openings on both ends. The tip of the PICC line sits in a big vein just above your heart. The other end of the PICC line comes out of the arm by about 5cm. The hollow space inside the line is called a lumen. You may have a line with a single or double lumen. Not all patients are suitable for a PICC line, but your suitability will be assessed by a member of the Radiology Vascular Access Team; either a specialist doctor, nurse or radiographer who has been specially trained to perform the procedure.
Please contact the radiology appointment team on 0191 445 2491 prior to your procedure if:
- You are, or might be, pregnant
- You weigh more than 200kg or 31 stone
What are the benefits of the procedure?
A PICC line is ideal for people with small veins or who are scared of needles, and especially for people who need to start intensive treatment immediately or are unable to have a different type of line because they are on blood thinning medication or unable to lie flat. It can be used for home treatment by a district nurse. If the line is cared for appropriately it can remain in place for six to eight months.
In summary, a PICC line can be used for:
- giving intravenous medicines
- giving chemotherapy or other irritating medications
- intravenous feeding
- giving blood and blood products like platelets
- taking blood samples.
How do I know if this is a suitable procedure for me?
Your doctor has suggested this as the most suitable test for you.
Can I take my medication as normal?
This will be discussed during your pre assessment in the x-ray department.
What happens during the procedure?
If your line is being placed as an out-patient you will be asked to attend the Procedure Investigation Unit. Here you will be checked in and changed into a hospital gown. Your line will either be placed using a machine which looks for changes in a tracing of your heart, called Sherlock 3CG or using x-rays. If your line needs to be placed using x-rays, a porter will collect you and take you to x-ray for your procedure. If your line can be placed using Sherlock 3CG, this will be done on the procedure investigation unit.
A member of the radiology vascular access team will explain the procedure and give you an opportunity to ask questions. You will be asked to sign a consent form. They will then scan your arm with an ultrasound machine to see the veins inside your arm. This will help determine the right size and type of vein to place the PICC line in. The person putting in the PICC line will wear a surgical gown and gloves. You will be covered in a surgical drape this is to ensure everything is kept clean. Your arm will be cleaned with antiseptic solution, and then you will be given an injection of local anaesthetic to numb the insertion site. You should not feel any pain during the procedure. However, you will feel some pressure on the insertion site at certain points. If needed, an x-ray will be taken during the procedure to check position of the line. If your line is placed using Sherlock 3CG, you will have a small plastic paddle placed on your chest which allows the practitioner placing the line to watch a tracing of your heart.
A small device called securacath will usually be placed to keep the line in place. This has small metal legs which sit underneath the skin and stop the line from accidentally coming out. You will not feel this being put in as the area will be numb from the local anaesthetic. A transparent, breathable dressing will be applied on the insertion site to secure the PICC line. The procedure will take approximately 30-60 minutes.
Occasionally it may be difficult to insert the PICC line and the procedure may be unsuccessful, or we may try the procedure in your other arm.
What happens after the procedure?
Most people who have had this type of procedure under local anaesthetic will be able to leave hospital after an hour. The actual time that you stay in hospital will depend on your general health, how quickly you recover from the procedure and your doctor’s opinion. You will be able to drive yourself home.
Once the local anaesthetic wears off, you may feel some slight discomfort or ache in the arm where
the PICC line was inserted. This is quite common. Most people do not need any pain relief, however, if required, you can take your usual painkillers (make sure you follow the instructions on the label).
There may also be some bruising around the insertion site and blood on the dressing. This is nothing to worry about.
In some cases, there may be some tenderness or swelling around the insertion site. This is quite common, especially during the first week following the procedure. Make sure that you continue to move your arm normally and apply some warm pads on the insertion site as needed or until the reaction settles. However, if the pain and swelling persist, please ring the hospital (see contact Radiology) and we will assess your condition and give you the appropriate advice.
What complications can happen?
Insertion of a PICC line carries a small risk of complications which are described below. These will be explain these to you in person before the procedure
- Infection – there is a small risk of having an infection. This can happen anytime while the
- PICC line is in place.
- Thrombus or clot – this can form around the line. Patients who have blood clots often report having painful and swollen arms. You must let the nurse looking after you know if you get these symptoms so we can treat the clot immediately.
- Malposition – in some cases, the tip of the line may not be in the correct position.
- Bleeding and bruising around the insertion site – sometimes a small ooze of blood may be seen around the insertion site. Gentle pressure may be applied after the procedure to prevent bleeding, especially for patients with blood that does not clot normally.
How soon will I be back to normal?
Following your initial dressing the line will need to be redressed and checked weekly. To prevent your line from blocking it will need to be flushed before and after each use.
If your line is not in use it can remain in place, but it needs to be flushed and dressed once a week. If you are an in-patient this will be done by a ward nurse. If you are an out-patient it will be done by a district nurse or GP practice nurse.
When you get home it is important that the transparent dressing is kept dry at all times. When having a bath, make sure that the insertion site and the tip of the PICC line are not sitting in the water. You must not go swimming. This will prevent your PICC line from getting infected. Also, you should avoid strenuous activities such as golf and tennis while the PICC line is in, as it can dislodge the PICC line or accidentally pull it out.
Most PICC line insertions are trouble-free, but please contact us if you notice any of the following:
- bleeding from the insertion site
- a temperature of 38°C, fever and chills especially right after the line is flushed with saline
- leaking or cracked line
- pain and swelling of the arm, neck and chest
- the external visible length of the PICC line is longer than when first inserted
- redness and inflammation of the insertion site.
If you have any concerns, please do not hesitate to call us on the numbers provided.