Intravenous (IV) Therapy Team - HMR Intravenous Therapy Team (HITT) - PICC and Midline

What is Intravenous Therapy?

The terms intravenous, IV are used when medicine is given straight into your blood, in a vein. This is done by using different devices such as an IV cannula, Midline line or PICC line. The device that is used will depend on the treatment you are having and how long you need the treatment for.

What is a Midline?

A Midline is a short hollow tube that is put into one of the large veins in your arm, usually in the bend of your elbow. It is put into a vein and goes no higher than your armpit. It can stay there for a few weeks. This is inserted in a very clean way ANTT (Aseptic Non-Touch Technique).

What is a PICC line?

A PICC (peripherally inserted central catheter) is a long hollow plastic tube that is inserted with a needle through the skin, into one of your large veins and the ends sits near your heart. The needle is then removed so only the plastic tube is left in your vein. This is inserted in a very clean way ANTT (Aseptic Non-Touch Technique) sometimes in theatre and can stay in for up to six months.

Why do I need a PICC line or Midline in?

The type of treatment you are having needs to be put into your vein for a period of time. The veins in your arm are the best veins to use. A Midline or PICC line should mean you will have fewer needles for the length of time you are having the treatment as the lines can stay in for several weeks.

How is the Midline or PICC put in?

You will be positioned on your bed or chair with your arm out to the side. A specialist trained doctor or nurse who has had special training will put the line in.

They will put a needle in your arm to where the arm bends. After this, they will put the Midline into your vein. This will take approximately 30 to 45 minutes in total. A Midline will be ready to use straight away.

Following insertion of a PICC line, you will have a chest x-ray to ensure the line is in the correct position. When the x-ray shows the line is in the right place then it is ready to use.

How is the midline or PICC kept in place?

Both the Midline and PICC line are kept in place with a fixation device and a clear dressing over the top.

The dressing helps prevent infection getting into the vein. To prevent infection entering the line, there is a plastic cap called a ’bung’ attached to the end of the line.

The bung and the clear dressing are changed weekly or earlier if dirty, wet, or loose. Please keep you dressing clean and dry.

Will I be able to move my arm?

You will be able to feel the line in your arm, but it should not stop you carrying out your usual activities. Excessive exercise should be avoided as this may make the line move. If you notice any redness or pus around the entry site that is new to you, then you should contact the IV Therapy Team and arrangements will be made for you to be reviewed.

Your line will be monitored daily for any signs of infection by the nurse. You should avoid heavy lifting and excessive movement of the arm. Some people may return to work with a peripheral cannula or a midline, but it must be light duties.

Are there risks with having a Midline or a PICC line?

The risks are the same when the line is in, for both Midline and the PICC line. The main risks are:

Infection: The nurses will care for the line and observe for infection daily, if you are self-administering your own IVs then you must wear sterile gloves, this is one of the main ways to prevent infection. If the dressing over the line gets wet it must be changed as soon as possible as bacteria can grow in damp environment.

Mechanical phlebitis: The Midline and PICC line are slightly smaller than the size of the vein, so the vein can take time to get used to it. This usually settles down and gives no further problems. To try to stop this happening, apply a warm dry compress (e.g. a warm dry towel) 4 times daily for 20 minutes each time for the first 3 days after it is put in. This helps the vein to open and let’s blood flow around the line.

Thrombus (blood clot): The insertion of any line into a vein causes damage to the vein wall. This damage can occasionally cause a clot to break off and block a large vein. Over time when a line is in a patient, a clot can attach to the end of the line.

Burst line: The nurses will always use the correct size syringe on the line, as the incorrect one may damage the line.

What happens if my line bursts or breaks?

The part of the line most likely to burst or break is at the end of the tubing near where the treatment is given. This can happen when too much pressure is put on the line. If this should happen the nurse will arrange for the line to be removed.

Can I have a bath or shower?

You can still shower or bath as long as the line is kept clean and dry. The Midline or PICC line should not be immersed in water, if the dressing becomes wet, inform the nurses as the dressing needs to be changed as soon as possible.

Can I eat and drink before a Midline or PICC line is inserted?

Yes, you can eat and drink as normal.

What are the signs of an infection?

If you experience any of the following symptoms, please inform the nurse as soon as possible as these could be signs of infection:

• Pain
• Swelling
• Chills or Sweats
• Feeling generally unwell
• Heat or redness around the cannula or up in your arm
• Raised temperature

How to take care of your line?

• Try to keep the dressing clean and dry. A rubber glove or cling film can help with this when washing
• Only touch the line when you need to
• Do not pull the line or anything that may be attached to it
• Take care especially when changing clothing
• Report any problems as soon as possible to the IV Therapy Team

If your line falls out completely:

• Apply pressure over the entry site into our skin for 5 minutes using a clean tissue or swab
• Elevate your arm
• Make sure you put the line in the bin safely
• When the bleeding has stopped, apply a plaster
• Contact the IV Therapy Team as you may need a new IV device in before your next treatment

What does IV Treatment involve?

This means a nurse administering your IV Medication daily in clinic. You will be given written information and contact details for the IV Therapy Team.

Additional Information

Your general practitioner (GP) will be aware that you are having IV Therapy. If you have been sent home from hospital, then all your medication will be given to you before you go home. All your other medications will be dealt with by your GP.

Contact us:

Heywood, Middleton, and Rochdale Intravenous Therapy Team (HITT)
We are based within - SDEC (Same Day Emergency Unit)
Level B
Rochdale Infirmary
Whitehall Street
Rochdale
OL12 0NB

Office Telephone No: 01706 517985 – Monday to Friday, 8am to 4pm

Duty Phone No: 07966240712 – 7 days a week, 8am to 8pm
Email: rochhitt@nca.nhs.uk

Patient Advice and Liaison Service

The Patient Advice and Liaison Service (PALS) acts on behalf of service users, families and carers to negotiate prompt solutions and help bring about changes in the way that services are developed.

As well as providing a confidential advice and support service, PALS will help guide you through the different services available from the NHS.
Telephone: 0161 778 5665
Email: pals@nca.nhs.uk

Comments and Complaints

We want to learn from comments and complaints about our services. If you have any, please speak with a member of staff. Every effort will be made to resolve any concerns and complaining will not cause any difficulties in your care with us.
E-mail: office.complaints@nca.nhs.uk
Telephone: 0161 656 1141

References

PAGE 24 & 29 Dougherty L, Watson J (2008) Vascular access devices: insertion and management. In Dougherty L, Lister S (Eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Seventh edition. Wiley-Blackwell, Oxford, 855-918.

Page 24 & 29 Higgins D (2004) Peripheral venous cannulation.
Nursing Times. 100, 41, 32-33.

Scales K (2005) Vascular access: a guide to peripheral venous cannulation. Nursing Standard. 19, 49, 48-52.