PICC Line

What is a PICC line?

A PICC line, the full name being peripherally inserted central catheter, is a long, thin, flexible tube placed into a vein higher up your arm and guided through to a large vein close to your heart. It's used to deliver medicines, fluids or nutrition straight into your bloodstream, or to take blood samples, sparing you from repeated needles.

What is a PICC line used for?

• chemotherapy and other cancer drug treatments
• antibiotics given over a longer course
• liquid nutrition, for anyone unable to eat or drink enough
• fluids or blood transfusions
• taking blood samples for testing

A PICC line tends to get recommended when treatment is needed regularly across several weeks or months or when the medicines involved would otherwise irritate the smaller veins in your arm.

What are the benefits of a PICC line?

• far fewer needle sticks for medicines and blood tests
• less irritation to your veins compared with repeated standard IV use
• flexibility to have treatment in hospital, at a clinic, or at home
• the option of more than one treatment at once, where the line splits into separate channels

Are there different types of PICC line?

Some PICC lines carry a single channel, while others split into a couple of separate lines, letting you receive more than one treatment at the same time.

A PICC line is one option among several long-term lines. Depending on what suits your treatment, your team might instead discuss a central line, placed in a vein in the chest or neck, or an implantable port, a small device fitted under the skin.

What happens before a PICC line is fitted?

Your healthcare team will review the medicines you're taking, along with relevant history, previous breast cancer treatment, removal of lymph nodes from your armpit, a pacemaker or similar device fitted in your chest, irregular heart rhythm, or kidney problems.

You might have blood tests beforehand to check your clotting and kidney function. Tell your team if there's any chance you could be pregnant, since procedures involving radiation-based imaging aren't suitable during pregnancy.

What happens when a PICC line is put in?

1. You lie down, with a monitor keeping tabs on your pulse and general readings throughout.
2. An ultrasound scan helps find a suitable vein higher up your arm, and the skin there gets cleaned and draped with a sterile sheet.
3. A local anaesthetic numbs the area; you may notice some pressure, but you shouldn't feel pain.
4. The line is threaded along the vein in your arm, up into a large vein just above your heart, with the other end left outside your body, usually near your elbow.
5. The line is secured with a dressing and a locking device, and a chest X-ray or ECG may confirm it's correctly positioned.

The whole procedure typically takes between 20 and 60 minutes, and most people are back home again by that evening.

What does recovery look like?

You may notice mild discomfort, bruising or puffiness near where the tube enters your arm for a week or so afterwards, which usually resolves on its own. Simple painkillers, such as paracetamol, can help if needed.

Your team will show you how to care for your line, keeping the dressing clean and dry, with changes roughly weekly. The line itself needs flushing with a saline solution, weekly if you're not having treatment regularly.

Avoid activities that repeatedly swing or jolt the arm, such as golf, tennis or contact sports, and avoid lifting more than around 10lbs with that arm. A waterproof cover lets you shower as normal, and most everyday activities can carry on as usual.

How long a PICC line remains in use varies, weeks, months, or occasionally beyond a year, depending on what your treatment calls for. Taking it out involves easing the line free with gentle, steady pressure, and is generally over quickly with little to no discomfort.

What are the risks and complications?

Possible risks of a PICC line include:

• bleeding or bruising at the insertion site
• infection at the site or in the bloodstream, needing prompt treatment with antibiotics
• a blood clot forming around the line, causing swelling or pain in the arm
• inflammation of the vein
• the line becoming blocked, shifting out of position, or coming out partially or fully
• rarely, injury to a nearby artery, nerve or tendon during insertion
• rarely, an air bubble entering the bloodstream

Overall, PICC line insertion succeeds in more than 95 in 100 attempts. Get in touch with your healthcare team without delay if you notice redness, swelling, a fever, chills, breathing difficulty, or discomfort while the line is being flushed or used, since any of these could point to infection or a related problem.