You and your PICC line

A PICC line is a long, thin flexible tube, known as a catheter, which is inserted into one of the large veins in your upper arm. This catheter is then threaded through your veins until the tip sits in the large vein just above the heart.

Generally, the PICC lines that are inserted at the hospital are single tube (lumen) lines but other types are available that have two or three lumens.

A PICC line can remain in place for many months while you are receiving your treatment. If you need any further information about a PICC line, please contact the clinical interventions team on: 0151 556 5737 Monday - Friday 8:00am - 5:00pm. 

PICC lines are inserted for several reasons:

• Chemotherapy regimens that require you to have a portable pump
• Small veins that are difficult to access repeatedly for the administration of intravenous (IV) chemotherapy or other IV drugs
• Patients who are extremely anxious about needles
• Patients whose veins have become painful or more difficult to access due to chemotherapy
• PICC lines can be used to take blood samples, or to be used in other hospitals for supportive treatments, procedures or imaging requirements if the staff are qualified to do so

You may eat and drink normally the day you are having a PICC line, it is not necessary to have your blood taken prior to the insertion or to stop any blood thinning medications you may be taking. 

A specially trained nurse will insert your PICC line and will explain the procedure fully to you. The nurse will assess the deeper veins in your upper arm using an ultrasound machine to select the most suitable site for the line. Local anaesthetics are available and will be used to make the procedure more comfortable. 

You will be required to lie quite flat for approximately 30 minutes and will be asked to position your arm at an angle away from the body to assist with the positioning of the line. This helps make the insertion of the PICC more successful.

The nurse placing the PICC will wear a surgical hat, mask and gown and prepare their work area carefully to ensure that the procedure is carried out as safely as possible, there may be two nurses in the room. Occasionally we have visiting students in the unit who benefit by watching specific procedures, you will be asked if you are happy for visiting staff to be in the room.

Once the PICC line has been placed successfully, the nurse will secure the line by using a small device called a Securacath and suitable clear dressings. The Securacath will remain on the line until the line is removed and will help reduce the likelihood of the line being pulled out accidentally, dressing changes and line flushes are scheduled weekly to maintain the functioning of the line.

It is possible for a family member or friend to be supported and trained to complete home line care. A bandage is often used over the site for a couple of hours. This bandage can then be removed by the patient later the same day, leaving the other dressings in place.

The PICC line can bleed after the insertion which is normal, if the dressings remain dry it is safe to leave until chemotherapy is due when the dressings will be completely changed. If the bleeding is excessive and blood oozes out onto the clothes please you should contact the triage helpline to request a dressing review either in a local chemotherapy clinic or via triage.

CIT [our Clinical Interventions team] can manage this if within working hours of 8:00am to 5:00pm Monday to Friday. Routine PICC line care can be managed by district nurses; within one of the chemotherapy units if appropriate or by relatives/friends if required. Training can be provided to accommodate these requests.

Specialist equipment similar to normal Electrocardiography (ECG - a heart rhythm recording machine) is used during the placement of the PICC to help the nurse locate the tip of the line. Three small stickers that are connected to the equipment will be placed at certain points on the body. When the nurse is confident that the line position is correct, the procedure is completed, the area cleaned following which the patient may go home or onto their next appointment. Occasionally, it will be necessary to obtain a chest X-ray to confirm the position of the PICC.

Occasionally, it may be difficult to thread the PICC along the vein of choice or to place the line into the correct position, making the procedure unsuccessful. Other choices or options will be discussed, if this happens.

Whilst you have a PICC line, it is vital that anyone who handles the PICC or redresses the site has a good standard of hand hygiene by washing their hands with antibacterial soap/gel first and by using a sterile method during all actions taken with the PICC or at the exit site.

It is important that your PICC exit site remains completely covered at all times, even when being used. When at home; it is best that the entire line is covered and secured comfortably when not in use, this reduces infection risks, or risks of the line getting pulled out of the correct position.

The PICC line needs to be cleaned, redressed and flushed with saline once a week by trained staff from The Clatterbridge Cancer Centre, by district nurses or by family/friends to prevent the line becoming blocked. It is essential to keep the line clean and dry at all times, so when bathing or showering it helps to cover the area.

The team will provide a few "shower sleeves" which can be used multiple times to keep the line dry, wrapping the area in "cling film" is also useful. There are commercial products that can be bought which are available from large chemists, shops or the internet, please discuss options with the nurses who are placing your PICC for suggestions.

You can lead a normal life with a PICC line in place, but there are some things that should be avoided. Swimming is not possible; some heavy work or certain sports may need to be adapted. A PICC line should not be removed automatically to allow for a holiday overseas. Please discuss this with the PICC team who will be able to offer advice or suggestions.

If you have any concerns, please contact the triage nurse via The Clatterbridge Cancer Centre Hotline, telephone number 0800 169 5555.

The nurses caring for your PICC line will document their actions in your hand held PICC records that will be given to you when your line has been placed successfully. These records should always be taken to every hospital appointment where your line is being used so that they can be updated regularly.

If you attend any other clinical setting, staff should be made aware of your line details. We strongly advise you to ask staff to use these records as they are a valuable resource and can limit lines being used incorrectly or removed unnecessarily. There is information in the documents that can also assist accident and emergency departments if you need to attend for any reason or used in.

When your line is no longer required, it will be removed by either your chemotherapy nurse on your last treatment appointment, the PICC team or, sometimes, your district nurse. This is a simple procedure with no specific preparation required.

Infection

PICC lines can become infected, including an infection within the line, systemically within your blood or confined to the exit site. Please report any pain, redness or oozing from the site immediately to the triage nurse via The Clatterbridge Cancer Centre Hotline number. Please check your temperature, if feeling unwell, and report any temperature above 37.5°C. Infections are suspected if you feel unwell and shivery after a line has been flushed. If this occurs, you will require antibiotics to resolve the confirmed infection. PICC lines should not be removed without investigation and microbiology results to confirm the infection.

Blood clots

Blood clots can develop in the vein along the route where the PICC line is sitting. Please report any swelling to your arm or neck, axillary pain or discolouration to the arm that the PICC has been placed into immediately to the triage nurse via The Clatterbridge Cancer Centre Hotline. If you develop a clot, you will be prescribed specific blood thinning medication treatment. It is not necessary to remove your line if this occurs as the line may be used as normal. 

Breaks and leaks

PICC lines can break and leak from the broken area. Should you notice any damage or leakage from your line, contact the triage nurse at the Centre immediately. Rarely, a PICC line can irritate or press on the lymph nodes within the axillary area of the arm the line has been inserted into; this can result in lymph fluid leaking from the exit site. Lymph fluid is a yellowish clear fluid and can make it difficult to maintain dry dressings requiring either line removal or twice weekly dressings.

Position

The line can come out from the correct position if it has not been possible to use a Securacath device on your line; this will be obvious when the nurse documents the exit length in your hand held PICC document. Please inform the Centre if you believe the line has moved

Giving blood back

Occasionally, the PICC line can stop giving blood back. Do not worry if this happens, as one of your nurses will administer a solution into the line that will help resolve this problem, alternatively the clinical interventions team can arrange this for you with a separate appointment.

Aching

Sometimes, during the first 72 hours, your arm can ache after having a PICC line placed. This is called mechanical phlebitis, and occurs when the vein becomes irritated by the insertion which settles over time. Try placing warm compresses on your arm or shoulder to help ease this, particularly within the first 24-72 hours, and simple analgesia may help. If worried, do not hesitate to contact the triage nurse for further advice.