Peripherally Inserted Central Catheter (PICC) Line Placement

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A PICC line is placed to provide repeated access to your veins in order to give medications, fluids or blood products. These types of lines are typically used for patients undergoing treatment for cancer or other serious illnesses for which access to a patient’s veins is needed for several weeks or for as long as six months. Under the guidance of X-ray imaging, a doctor feeds a long thin tube – called a catheter – from a vein in the arm into the large vein in the heart (the super vena cava) to place the PICC line. An external site remains to provide access during the patient’s ongoing treatment.

Need to Know

Nice to Know
  • Don’t take aspirin or Vitamin E at least 5 days before
  • Do not eat or drink anything at least eight hours before the procedure
  • If you have diabetes, ask your primary care doctor about adjusting your insulin dose
  • Tell your technologist about any allergies, especially to local or general anesthetics and contrast materials (“x-ray dye”)
  • Inform your technologist if you are pregnant
  • Before your procedure, you’ll meet with your Jefferson Radiology physician for a consultation
  • Wear comfortable, loose-fitting clothing
  • You’ll be given a gown to wear during your treatment
  • You’ll be awake during the procedure and most-likely can go home after
  • No surgical incision is needed, just a small nick in the skin
  • You may feel some discomfort after the procedure, but no serious pain

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How Does It Work?

Under the guidance of fluoroscopy (a type of X-ray that can see motion in real time), your doctor will locate the vein in your arm and insert a small needle. Your doctor will then feed a small guide wire through the vein to the superior vena cava. Once the wire is in place, a catheter is inserted over the guide wire and moved into position. The guide wire is then removed.

What Happens — Before, During, and After?

When you arrive for your procedure, a nurse will greet you and let the team know you’ve arrived. Before the procedure, you may have an ultrasound, CT, or MRI exam.

A nurse will bring you into the pre-procedure area and ask you to change into a gown. When you are brought in for your procedure you will be positioned on the examining table. The technologist or nurse will connect monitors for your heart rate, blood pressure, and pulse, and an intravenous (IV) line will be inserted into a vein in your hand or arm. This will be used to give you sedatives during the procedure. Some patients receive general anesthesia, but in most cases, this is not necessary.

The technologist will shave, sterilize, and cover the area of your arm where a catheter will be inserted with a surgical drape. Your doctor will numb the area with a local anesthetic. You may feel a small pinch as the anesthesia is given. Once the area is numb, your doctor will make a very small nick, and you may feel some pressure as the guide wire and catheter are inserted, but you won’t feel any serious discomfort.

Once the catheter is in place the wire will be removed. Pressure will be applied to stop any potential bleeding and the catheter will be taped in place on your arm. You will not need stitches. The procedure usually takes 30 to 40 minutes. You will then be taken to a recovery area to rest. When you feel ready you will be able to go home.

Your doctor will give you specific instructions on caring for the catheter site, including how to flush it to keep it clean and prevent clots and how to avoid other potential risks. You will likely need to keep the catheter site dry for at least a week after the procedure.

You may feel some discomfort after the procedure. This can usually be treated with over-the-counter pain medications. Please tell your doctor if you experience any swelling or major discomfort or develop a fever.

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How Should I Prepare?

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or — as you’re doing now — educate yourself about the procedure.

Some other things to keep in mind in planning for this procedure include:

  • You should plan to have someone take you home after the procedure as you will not be able to drive after sedation.
  • You will need to get blood tests to check your liver and kidney function.
  • Your doctor may also request an EKG.
  • Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or blood thinners (such as Coumadin or warfarin) for a time before the procedure.
  • Five days before the procedure, stop taking vitamin E.
  • The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a nurse from the Interventional Radiology Department will call you. The nurse will give you any additional instructions, and will ask if you have any questions.
  • In the 8 hours before the procedure, do not eat food.
  • Up to 2 hours before you arrive at the hospital, you may drink clear liquids. Black coffee or tea are fine, but do not add cream or milk. You may sip water with medications.
  • When you arrive, make sure the nurse and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics (such as propofol), or X-ray dye (contrast media). If there’s any chance you may be pregnant, tell your radiologist.
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What Should I Bring?

On the day of your procedure you should:

  • Wear comfortable, loose-fitting clothes
  • Wear comfortable shoes
  • Avoid bringing jewelry or valuables
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What Are the Benefits and Risks?

The benefits of a PICC Line Placement may include:

  • Allows medication to be given without certain complications associated with IV lines, such as irritation of the vein walls or tissue damage if a toxic drug leaks out of the vein.
  • Eliminates repeated needle sticks for patients undergoing ongoing treatment or therapy
  • Eliminates the side effects of repeated IV lines such as scarring of arm veins
  • PICC lines are easily removed once they are no longer needed

Some risks that you should be aware of include:

  • Like any procedure that involves a catheter, there is a risk of damage to blood vessels, bruising, bleeding, or infection at the puncture site.
  • There is a risk of bleeding. Your doctor will need to check your blood before the procedure to ensure that your blood clots normally.
  • In some cases, patients may experience an abnormal heart rhythm while the catheter is being placed. This is usually corrected by adjusting the catheter position.
  • There is a small risk that the catheter will enter an artery rather than a vein and need to be removed. In most cases the artery then heals itself. However, sometimes surgery is required to repair the artery.

There are also some risks involved with having a PICC line in place. Your doctor will provide you with detailed instructions which can lessen the likelihood of most of these risks. However, these risks include:

  • Infection at the site of the catheter or in the blood stream
  • The catheter can occasionally break or become dislodged requiring first-aid action
  • If a large amount of air enters the catheter it may cause chest pain or shortness of breath requiring emergency treatment. This can be avoided by ensuring that the catheter is always clamped when not in use and the cap is screwed on tightly.
  • Clots can form in the catheter causing swelling
  • Irregular heartbeat is sometimes caused by the catheter, requiring adjustment by your doctor

Your doctor will provide you with detailed information about each of the above risks and what to do if you encounter any of the above complications.

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.

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