Radiology - Having a PICC (Peripherally Inserted Central Catheter) Inserted under X-ray Guidance

What is a PICC line (Peripherally Inserted Central Catheter)?

A PICC line is a long, thin, flexible tube known as a catheter. It is normally inserted into one of the large veins of the upper arm and can be performed on the ward or in special cases within Interventional Radiology. The end tip of the line sits in the lower third of the large vein above the heart.

The space in the middle of the tube is called the lumen. Sometimes the tube has several lumens which allows different treatments to be given at the same time. At the end of the tube outside the body, each lumen has a special cap, to which a drip line or syringe can be attached. PICC lines can also be CT compatible, which means CT contrast can be administered through this line.

Why do I need a PICC?

Your doctor has decided that you require fluids or drug treatment into your bloodstream for a long period of time or that the drug you require must be given through a large vein near the heart.

In some situations, a PICC can be used for taking blood samples. If the line is being used for Parenteral Nutrition, then it is not safe to take blood samples and blood samples will be taken using the traditional method of a needle into your skin.

If necessary, a PICC can stay in for up to 2 years.

Are there any alternatives?

The alternatives to having a PICC are as follows:

• Cannula - If you continue to have your treatment through a cannula you will require this changing every 7 days or sooner if there are signs of irritation to the vein
• Midline - This is similar to a PICC line but the tip of the line ends in the veins in your armpit. Not all medication can be given through a midline. A midline can only stay in place for between 4 weeks 6 months
• A different central line - If a PICC is not appropriate for you there are other types of central lines that can be inserted through your neck or chest. A doctor or nurse will discuss this further with you if you require this type of line

Who will put in my PICC?

Your PICC line will be inserted in Interventional Radiology. This may be because your veins are problematic due to your anatomy or because you have had previous lines or clots. This can make inserting the PICC on a ward tricky and therefore it will be inserted under x-ray guidance in the Interventional Radiology Department. A specially trained radiographer or doctor will insert the line.

Before inserting the PICC they will discuss the PICC insertion procedure, any benefits, alternatives and potential risks and problems.

You will be offered the opportunity to discuss any issues and will also need to consent to the procedure.

The procedure is completed under local anaesthetic and unless you are told otherwise, you can eat and drink normally before and after the procedure.

Who will care for my PICC?

While you are in hospital the nurses will look after your PICC. This involves cleaning the exit site, applying new dressings, changing the bungs and flushing the line to prevent blockage.

When you leave the hospital, your local community nurses may be contacted to care for your PICC at your home.

How long will the PICC insertion procedure take?

The procedure usually takes between 60-90 minutes. From explaining and discussing the procedure, assessing your veins for suitability and placing the PICC.

How is the PICC inserted?

The procedure will be done with you lay on the x-ray bed; you will be lying down with your arm extended to the side. The specialist will clean the site, place sterile drapes around the area, and inject a local anaesthetic to numb the area where the line is to be inserted. Next, a special needle is used to locate a suitable vein in the top of your arm. The PICC will be fed into the vein.

The procedure is usually pain free, though some patients do feel some minor discomfort.

You won’t be able to feel the PICC being threaded up through the vein.

The PICC is secured with an orange device called ‘Securacath’ or with a ‘Statlock’.

Once the PICC is in place it will be covered with a clear dressing. Some patients have a larger dressing placed to stop them getting a large bruise. This is more likely if you take medication that thins your blood.
 
The dressing will be changed the next day and then on a weekly basis unless it becomes soiled then it will be changed sooner.

How will the PICC affect me?

Your PICC line will be put in your upper arm so you will be able to use your arm normally.

You can shower but will need to protect the line and dressing from getting wet, you can use a protective sleeve, Cling film or a plastic apron.

Common problems with PICC line insertions

Most PICC insertions go smoothly, but occasionally there are problems. Sometimes, the shape of the vein can prevent the PICC from being threaded upwards. If this happens, we will probably try again using a different vein.

Sometimes the PICC goes in easily but the x-ray shows it is in the wrong position. When this happens, we are usually able to adjust the position using a special flushing technique or by re-threading the same line.

During the procedure you may feel a shooting pain down your arm if the needle touches a nerve.

What can go wrong with PICCs?

Many patients don’t have no issues with their PICC, but there are certain risks involved.

It is important for you to know what can go wrong so you can help prevent or deal with the problem if it happens. The person putting in your PICC will spend time explaining this in detail.

• Thrombosis (blood clot) - Having a PICC sitting in a vein increases the risk of developing a blood clot. This sounds very alarming, but in fact when it does happen, it’s very unlikely to cause a serious problem. If, on the same side the PICC is placed you have any pain, redness or swelling in your arm or neck - this could be a sign that a blood clot has formed in one of the veins. Patients who develop this type of clot are usually given medication. There is often no need to remove the line and it can continue to be used
• Dislodgement - If your PICC becomes dislodged, or pulled out from its original position, please inform the team caring for you. If your PICC has partially fallen out of place you should fix the line to your arm with tape or a plaster and let your team know. If the PICC has completely falling out you should apply pressure to the insertion site if it is bleeding and cover with a plaster
• Infection - This can be a problem and therefore great care is always taken when inserting the PICC and when cleaning and flushing the line. Even so, infections can happen at any stage. Infections can often be treated with antibiotics, but sometimes we will need to remove the PICC to prevent the infection from getting worse
• Palpitations - Occasionally patients experience palpitations after the PICC has been put in. Some patients describe this as a “fluttering” feeling in their chest. Other people say they are aware of their heart beating more strongly than normal or with a different rhythm. When this happens the PICC will be pulled out by a few centimetres and the palpitations will usually stop straight away
• Not bleeding back - A PICC is designed to allow blood samples to be taken, but sometimes blood cannot be withdrawn. This is not a serious complication but if this happens your nurses will use special techniques or medication which usually solves the problem
• Damaged or split line - It is very important to prevent the PICC from getting damaged - for example, you should never use scissors near it. If the PICC splits or breaks, it will need to be removed
• Blocked line - Sometimes a PICC can become blocked. It is important that the line is always flushed before and after any medication is put through it. If this happens your nurses will use special techniques or medication to unblock the line. If a PICC cannot be unblocked the PICC will need to be removed

When to contact us?

Things to look out for:

• If you experience cold and shivery attacks during and after flushing your line or if you have a temperature above 38 degrees centigrade, it is very important that you tell a member of nursing/ medical staff
• Redness on the arm containing your PICC
• Tenderness, excessive head or pain in the arm or armpit of the arm containing the PICC
• Oozing from where the line comes out of your arm
• Swelling of your arm
• Leaking of the PICC
• Damage to your PICC or movement of the PICC position

How should I care for my PICC?

Your PICC should not stop you from doing anything that you would usually do. However, once the PICC is in place it needs to be looked after carefully to prevent problems from occurring. The nurse will perform weekly dressings, bung changes and flush the line.
 
The PICC will always be covered with a clear dressing. This keeps the PICC in place and reduces the risk of infection.

Please do not submerge the PICC in water or go swimming while your PICC is in place.

Sports such as tennis and golf and vigorous gym exercises are discouraged. There is a risk that your PICC could become dislodged because of excessive upper body movement.

Should the dressing get loose, dirty, wet and or start to peel off contact the nurse straight away so the dressing can be changed.
You should have no reason to touch your PICC unless you are undergoing self-administration therapies.

If you do touch your PICC always wash your hands prior to touching any part of the line and ensure anyone else who is dealing with your PICC also washes their hands.

Before using your PICC Nursing and medical staff MUST:

• Wash their hands
• Put on gloves and an apron
• Clean the end of the line with a wipe for 15 seconds
• Allow this to dry completely before accessing the PICC
• Flush PICC with normal saline before and after using line or weekly if not in use
• Remove gloves and apron
• Wash hands

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 206 5091 if your appointment is at Salford Royal Hospital. Please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office on:
0161 204 2044 or 2404 (Salford Royal Hospital)
0161 624 0420 (Royal Oldham Hospital)
Monday to Friday 8.30am to 4.00pm.

You can also email salford.booking.radiology@nca.nhs.uk (Salford Royal Hospital) or bookingandscheduling.outpatients@nca.nhs.uk (Royal Oldham Hospital)

Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact:
The Angiography Department, Salford Royal Hospital Tel: 0161 206 2206/5091
Interventional Radiology, Royal Oldham Hospital Tel: 0161 656 1178

Your PICC line

PICC line inserted on:
PICC line inserted by:
PICC line inserted: