PICC Line Insertion
Reviewed By : Dr. Aarti Joshi
Listed below is the step by step procedure of PICC line insertion:
- What is PICC Line Insertion?
- Why is PICC Line Insertion Required?
- Pre-operative Preparation
- Procedure Day
- Methods/Techniques of PICC Line Insertion
- Post Procedure
- Risks and Complications
What is PICC Line Insertion?
Peripherally Inserted Central Catheter (PICC) Lines are used while administering chemotherapy in course of cancer treatments.
A PICC Line is nothing but a long thin catheter. It has to be thin enough for passing it through a vein in the arms. A PICC line is a type of central venous catheter.
Why is PICC Line Insertion Required?
The prime purpose of performing PICC insertion procedure is the ease of administering patients with intravenous therapy through an intravenous catheter. The PICC is useful in patients for whom locating the vein access is difficult because of a host of factors like degeneration of veins, aging, narrowing of veins etc. A PICC line can also be used in event of hardening of the walls of the veins due to previous medical treatments. A PICC line is also useful for injecting pain medicine, chemotherapy drugs, foods and fluids and also for drawing out blood.
Following measures are those that are to be taken few days prior to your PICC line insertion:
- Medications to go off: You are asked to go off vitamin supplements or blood clotting tablets at least 5 days prior to procedure.
- Eating or drinking: You may be asked not to eat or drink anything at least eight hours before the procedure.
- Diabetic patient: If you have diabetes, the doctor may change your insulin dosage prior to the date of insertion.
- Allergies: It is better to tell the radiologist if you are allergic to any of the contrast material and anesthetics to be used during course of insertion. This may save you from an unsuccessful outcome.
- Pregnancy: Inform the radiologist if you are pregnant.
These steps mark the preparations that are required on the day of PICC line insertion, a few hours before entering the operation theater:
- Loose clothing: You need to wear loose fitting and comfortable clothes while on your way to the hospital for this procedure.
- Radiological examination: You maybe asked to undergo a CT-scan or ultrasound before the insertion is commenced.q
- Blood tests: Few blood tests are also ordered for making sure the kidney and liver are functioning properly before procedure.
- Liquids: Prior to insertion procedure, you are allowed to drink black coffee or black tea minus the milk content.
- Consent form: You are made to sign a consent form before the procedure.
- Intravenous line: An intravenous drip line is connected to your arm for injecting medications during the procedure. Another line also provides heart and pulse rate information to the operating surgeon.
Methods/Techniques of PICC Line Insertion
In the beginning of PICC line insertion procedure, the patients are made to lie on their back on a procedure table. The arm chosen for catheter insertion is rested with the help of an arm board support. A tourniquet (compressing device) for controlling the blood flow is placed for wrapping the arm right below the shoulder. Ultrasound is used for searching access point in one of the veins. The catheter insertion area is cleaned and shaved. A local anesthesia called Lidocaine is injected in the skin for making it numb. This anesthesia makes the patient oblivious to the pain which occurs during insertion. Thereafter, a catheter is guided into the vein using a thin wire. The catheter is then guided to the superior vena cava which is the large vein that transports blood to the heart from head and upper body.
After the above process, blood vessels adjacent to the catheter are checked for leakage of blood. Saline solution is then filled up in the catheter. The catheter position is confirmed through an X-ray. The catheter insertion site is sutured and then cleaned with an anti-septic solution. Other alcohol based solutions may also be used if deemed fit by surgeon.
You may experience, pain, swelling from the catheter insertion site. Also, leakage of fluid in that period imemdiately post insertion is also possible. This should be reported to the doctor as soon as possible. There may be bleeding from catheter insertion site, which should be sealed with the help of dressing from the nurse during hospital stay.
Following listed are the recovery tips to be followed in the weeks after discharge from hospital:
- Dressings: The dressings need to be kept blood-free and dry.
- Bathtub: Avoid bathing in a bathtub atleast for a few days post insertion procedure. Make sure to conceal the insertion site with transparent plastic wrap and tape for keeping the insertion site dry before having a bath.
- Avoid swimming: Avoid swimming for few days after undergoing PICC line insertion.
- Flushing the PICC Line: Learn the scientific way of cleaning the PICC line regularly.
- Heavy objects: Avoid anything that may put pressure on your arms. Avoid lifting heavy objects too. Use the arm other than the PICC line inserted one if blood pressure is to be measured.
- Rest your arm: Remember to rest your arm for one day after the insertion is done.
This is necessary as your arm may become sore and you may experience discomfort in that region for initial 2 days.
- Bleeding and bruising: A minute amount of bleeding and bruising from the insertion site after the procedure is possible.
- Hot water pack: Remember to apply a hot water pack to the area of PICC line insertion for the first 2 days at regular intervals
- Anti-inflammatory drugs: Follow the prescribed anti-inflammatory medication after meals.
- Total Parenteral Nutrition (TPN): TPN, also called as hyperalimentation, is infusion of nutrition through central line into the vein. TPN is used when the person has problems with eating and digesting food normally.
- Pets: If you have pets, do not allow them anywhere near the PICC line insertion area as they are likely to gnaw or chew on the line.
Risks and Complications
Remember to rest your arm for one day after the insertion is done.
- Blood clots: Formation of blood clots in the vein near the insertion site may occur. If blood clots form, medication may be prescribed for dissolving them or the line may be taken out.
- If you have pets, do not allow them anywhere near the PICC line insertion area as they are likely to gnaw or chew on the line
- Fluid leakage: Fluid leakage is another risk possibility occurring in course of PICC line insertion.
- Air in the PICC line: Air bubbles can get into the PICC line which can trigger breathing problems in the patient. Few PICC lines have clamps for sealing them while few have caps for keeping air out of it. The ends should be closed whenever not in use.
- The PICC line getting disconnected: The line coming out because of a loose dressing is a possible risk. The dressing that holds the PICC line should be tight and not loose to avoid it from coming out anytime.
- Break or cut in the PICC line: The PICC line should be protected from getting cut or broken. The area near the insertion could get nicked or cut in which case the line may need to be removed if the surgeon fails to repair it.
- Blood clots in lungs: Although rare, blood clot formation can take place in lungs because of PICC line insertion.
- Damage to nerves: During the insertion procedure, damage can occur to the nerves, blood vessels or tissues near the site of insertion.
To summarize, PICC line surgery is a catheter insertion procedure. Make sure to have a discussion with your doctor about the same.