PICC Line (Peripherally Inserted Central Catheter)

A PICC line, or peripherally inserted central catheter, is a thin, flexible tube that delivers treatments through a vein. It’s a type of intravenous (IV) line, and it’s used to help treat many medical conditions.

A PICC is a type of central venous catheter. Central venous catheters are kind of like regular IV lines that you may see when getting blood drawn or donating blood. But they’re much longer, thicker and more durable than regular IV lines. Healthcare providers use central lines to access the large veins in your chest.

What is a PICC line used for?

Healthcare providers use PICC lines when you need to receive treatments through your veins (intravenously) over a long period of time, or when the treatments are irritating to smaller veins. These treatments may include:

• Medications like antibiotics or chemotherapy
• Blood transfusions
• IV fluids
• Liquid nutrition (total parenteral nutrition)

Providers can also draw blood for laboratory tests from PICC lines.

What happens before your PICC line is placed?

Before you get a PICC, your healthcare provider will:

• Review the medications and supplements you take
• Review your health history for breast cancer, lymph node removal in your axilla (armpits), implanted devices in your chest like a pacemaker, atrial fibrillation and chronic kidney disease

Your provider may give you blood tests to see how your blood clots and to check on your kidney function. You may also get an imaging test to pinpoint vein locations.

PICC line placement

You lie on your back to get a PICC line. Your healthcare provider connects you to monitors to track your vital signs. Then, they use an ultrasound machine to find the veins in your upper arm. They clean your arm and cover it with a clean (sterile) cloth to prevent infection. Your provider gives you medicine to numb the area where they’ll place the PICC line.

Then, your healthcare provider threads the PICC line through a vein in your upper arm, just above the bend of your elbow. They guide it into your superior vena cava, which is the large vein above the right side of your heart. The other end (tail) of the PICC stays outside your body. It usually hangs just above where your arm bends.

Once the PICC is in place, your provider places a cap over the cover of the line. (The PICC may divide into two or three lines, each with its own cap.) Then, they attach the PICC line to your arm using special tape and cover it with a sterile bandage (dressing). Most people feel little to no discomfort during this procedure.

How long does the procedure take?

PICC line placement typically takes about one hour. This means that you can go home the same day.

What happens after it’s placed?

You may get a chest X-ray to make sure the PICC line is in the right place. You may also have a little pain or swelling near the insertion site for two to three weeks after your provider places the line.

You’ll be able to bend and use your arm just as you would without the PICC line in place. You should be able to resume most normal activities right away. You’ll need to avoid swimming, participating in contact sports and lifting heavy objects. Avoid sweating too much or exposing the dressing to water. Remember that your provider’s instructions are the most valuable and relevant to your specific needs. If you have any questions about what you can and can’t do, be sure to ask them.

How do I care for my PICC line?

Your healthcare provider will show you the best way to take care of your PICC line to keep it working properly and to help avoid infection. In general, to care for your PICC line, take the following steps:

• Dressing: Keep your bandage (dressing) clean, dry and securely attached to your skin. If it tears or gets wet, the dressing needs to be changed. Don’t put ointments or lotions under the dressing.
• PICC line dressing change: When it’s time to change your dressing, a nurse or licensed caregiver will change it for you. They’ll change your dressing once every seven days or sooner if it’s visibly dirty. Dressing changes are done very carefully to keep the site sterile and free of any bacteria. They should thoroughly wash their hands and wear sterile gloves before touching the PICC, dressing or skin under the dressing. If any supplies fall on the floor, throw them out. Do not reuse any supplies.
• Showering: Cover your dressing with a waterproof wrap when showering. Some people cover the dressing with a clean, dry washcloth before wrapping the upper arm in plastic cling wrap, then taping the top and bottom of the wrap to make sure water doesn’t come through. You may also use a waterproof cover designed for casts. Anything that keeps the dressing clean and dry while showering is OK.
• Flushing the line: You may need to flush your PICC line with a sterile solution such as saline. Follow your healthcare provider’s instructions for this. Remember to scrub the end of the PICC line (tip) with provided alcohol swabs for 15-30 seconds before connecting anything to your PICC.

Activity

There are some things you should avoid while your PICC is in, including:

• Anything that makes your PICC arm swing back and forth, or around in a circle (like golfing, bowling, jumping jacks, vacuuming), but you may use your other arm like normal
• Lifting anything over 10 lbs (about the weight of a gallon of milk) with your PICC arm
• Activity that makes your underarms sweat or exposes your dressing to extra water — keep your dressing as clean and dry as possible to avoid infection risk

PICC line removal

If there’s a chance you may need it again, your provider may recommend keeping it in to reduce the risk of damaging your veins. When your treatment is over, your healthcare provider will remove your PICC line. To remove the line from your arm, your provider will gently pull on the end of the catheter.

How long can a PICC line stay in?

A PICC line can stay in place for a very long time, if needed. Some PICCs stay in for more than a year. If the PICC is still needed and fully functional, it can stay in for use.

What are the benefits of using a PICC?

Using a PICC has many benefits. With the device, you can have:

• Fewer needle sticks for medications and blood draws (the goal is to spare your veins from these frequent needle pokes)
• Less vein and blood vessel irritation from IV medications
• Flexible treatment settings, like a hospital, nursing facility or at home
• More than one medication at a time, for PICCs with more than one lumen (tail)

What are the risks during and after the placement of a PICC?

While PICC lines have many potential benefits, they do come with certain risks during and after placement. These range in severity and may include:

• You may bleed at the insertion site.
• During the insertion of a PICC line, the needle can accidentally poke a hole through an artery, nerve or tendon near the insertion site, but this is very rare.
• A clot may form around the catheter in your vein (thrombosis). This can cause swelling and pain in your arm. You may need to take medication from your provider to help with swelling and pain.
• Inflammation in a vein (phlebitis) can develop from the use of all types of IVs, including PICCs.
• An infection may occur at the insertion site or in your bloodstream. Any infection raises the risk of a potentially life-threatening infection called sepsis.
• The PICC can come out — partially or completely — if not well-secured and completely covered.
• The PICC can move out of position in your vein, and your provider may need to remove or reposition it.
• The PICC may become blocked. You may need to take medication to clear it.
• An air bubble may develop in a blood vessel (embolism).

Sometimes, the PICC line insertion doesn’t go in right the first time, and your provider must try again. In some people, it’s not possible to put in the entire length of the PICC line. If this is the case, a midline catheter may be an option for you.

How successful is this procedure?

Overall, PICC lines are effective in more than 95% of placements.

When should I call my healthcare provider?

You should call your healthcare provider or go to the nearest emergency department if you experience any of the following symptoms:

• Fever or chills
• Shortness of breath or cough
• Dizziness or fainting
• Bloody drainage or leakage from the insertion site
• Pain or swelling in your face, arm or chest

Seek medical care promptly, as these are symptoms of sepsis, including the above symptoms. This is a life-threatening medical emergency that happens when your immune system overwhelmingly reacts to a spreading infection.

You should also call your provider if you experience any of the following complications from your PICC:

• Redness, warmth or a lump at the insertion site
• Tingling or pinching in your arm, hand or fingers on the same side of your PICC
• A change in the length of the tube
• Pain or discomfort when receiving treatment through the line