A key contraindication is that patients on anticoagulant therapy who have an INR blood test result greater than 2. In addition, certain conditions may affect which veins are safe for the insertion site. An upper extremity vein cannot be used for a PICC insertion if there is a history of any of the following in the region of that upper extremity:.
Similarly, a vein should not be used for a PICC insertion in any place on the body where the skin has a local dermatitis, cellulitis, burn injury, abscess or infection. Although rare, the risks associated with the PICC line procedure can include infection, bleeding, blood clot, increased venous thrombosis, pulmonary embolus, breakage of instrumentation during the procedure.
Pain can be expected during the injection of the local anesthetic and discomfort, or pain, may occur related to table positioning during the procedure. Adherence of the catheter within the venous system at the time of removal can occur when the catheter has been in dwelling for a long periods of time, although this is a rare occurrence.
Oral antibiotic therapy is an alternative in some cases, but may not be effective against certain types of infection or against infections in certain locations. Inadequate treatment of an infection could result in the further spreading or increasing severity of the infection.
Intravenous IV therapy can be performed with peripheral IV catheters, but these have to be replaced at least every three days and the veins typically become increasingly difficult to catheterize over time.
Long-term IV therapy can be performed with other central venous catheters for example, tunneled catheters or buried port catheters. Compared to the PICC, insertion of these catheter types is more invasive and their removal can be more complicated. Mild soreness can be expected at the entry site for one to two days after the procedure. There may be bleeding at the entry site, especially on the first or second day.
If the gauze becomes soaked with blood, a nurse should be told to change the dressing. It is important to keep the dressing and the external tubing dry. If showering, cover the dressing and external tubing with a waterproof material, such as plastic wrap secured with tape or a commercially available waterproof cast cover. Do not submerge the entry site under water. If the dressing gets wet, have a nurse change it as soon as possible.
Strenuous exercise should be done with caution to protect the PICC and only if permitted by your physician. The PICC should be flushed before and immediately after each use and flushing instructions must be followed carefully. Do not allow the external catheter to have hairpin turns, kinks, or twists, and be aware that the sutures should remain in until the PICC is removed.
Patients are given a catheter information book with phone numbers and a pager number to call in the event of a question or emergency related to the PICC. They should report any of the following to a nurse:. Develop and improve products. List of Partners vendors. A PICC line, or peripherally inserted central catheter also sometimes called a percutaneous inserted central catheter , is a medical device that allows ongoing access to the bloodstream for up to six months at a time.
It can be used to deliver intravenous IV fluids or medications, such as antibiotics or chemotherapy , and to draw blood or perform blood transfusions. Most facilities only allow a standard IV to remain in place three to four days before it is removed and a new one is placed. Over the course of many weeks, a PICC can substantially reduce the number of times you have to tolerate the poke of an IV being inserted into a vein.
It can also be used to give larger volumes of fluids and medications that are too irritating to the tissue to be given through a standard IV. A PICC line can be used for a variety of purposes when it is expected that a person will need to receive IV medication for prolonged periods.
A PICC line may be recommended for the following treatments:. In addition, people might need a PICC line in the following situations:. The PICC line itself is a tube with a guidewire inside to stiffen the tube to make it easier to thread into the vein.
The PICC line may be trimmed to a shorter length if necessary, especially if you are petite. The ideal length allows the line to extend from the insertion site to where the tip rests in a blood vessel outside the heart. The procedure, which takes about an hour, is typically done bedside in hospitals or long-term care facilities, or it can be an outpatient procedure.
A vein is selected, and the insertion site is typically numbed with an injection. The area is cleaned thoroughly and a small incision is made to access the vein. Using sterile technique, the PICC line is gently inserted into the vessel. It is slowly advanced into the blood vessel, where it goes up the arm and then makes its way toward the heart.
In many cases, sonography ultrasound is used to identify the best site for PICC placement, which can reduce the number of times you get "stuck" during placement of the line. Once the PICC is in the appropriate place, it can be secured to the skin outside of the insertion site. Most PICC lines are sutured in place, meaning that the tubing and port that rests outside of the skin is held in place by stitches.
This prevents the PICC from moving or being removed accidentally. Once the PICC is in place, an X-ray is performed to determine if the line is in the appropriate place in the blood vessel. If it is not in the appropriate place, it may be pushed further into the body or pulled back slightly. Once the placement is confirmed, the guidewire is removed and the line is safe to use. PICC lines carry some risks of complications, including those that are serious and potentially life threatening.
If there is a complication with a PICC line, it may need to be removed or adjusted, or additional treatments may be required. PICC lines require regular maintenance, including routine sterile dressing changes, flushing with sterile fluid, and cleaning of the ports. Preventing infection is key, which means keeping the site clean, keeping the bandage in good condition, and washing your hands prior to touching the ports.
A peripherally-inserted central catheter, or PICC line, is a long, soft, and flexible tube inserted into a vein in the upper arm. Doctors and nurses use it to administer intravenous IV therapy. A doctor can use the opening of the PICC on the outside of the arm to draw blood or administer fluids and medications without the need for continual needle pricks. This article outlines the benefits and risks of the PICC insertion procedure and compares it with similar methods.
It will also explain what a person can expect before, during, and after the procedure. PICCs can stay in place for weeks or even months at a time, meaning a person has to endure fewer needle pricks.
Another benefit of PICCs is that they can feature more than one lumen. A lumen comprises the tubing and caps that feed from various sources. Therefore, a patient can receive more than one medication at the same time. For example, they could receive chemo and fluids simultaneously. A person could get a PICC if they are receiving chemotherapy.
In these cases, they can go home and leave the PICC in place until they have their final treatment. Doctors can use a PICC to administer :. A peripheral IV line PIV is a short-term use device that doctors often insert into the forearm for up to 4 days. Although they can provide medications and fluids or allow for the drawing of blood, PIVs cannot accommodate all forms of chemotherapy.
Additionally, PICC lines can remain inserted for longer periods of time, which may be useful for people receiving long-term treatment. A port is a surgically-implanted catheter that doctors place in the chest. These ports can stay in place for up to several months. Researchers found that they led to fewer complications among participants.
Learn more about the pros and cons of different IV lines here. Some possible complications include :. A person should let a healthcare professional know if something happens to their PICC, for example, if they believe their PICC line has moved out of place. People should also talk with a doctor or nurse if they experience the following:.
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