A catheter is a thin plastic tube that is similar to an intravenous (IV) tubing used to allow patients to receive medications and fluids. APICC line is a peripherally inserted central catheter that consists of a soft, thin tube inserted into your upper arm vein (peripheral) and advanced to a position in the large vein inside your chest above your heart (central).

Because this method can be inserted for a long period of time, doctors may recommend placing a peripherally inserted central catheter or PICC line in special casues. Although it carries a low risk of complications, serious PICC line complications do occur.

What’s a PICC Line?

PICCs were first used in the 1970s as an alternative to centrally placed venous catheters, which were inserted directly into the subclavian, internal jugular, or femoral veins. Insertion of catheters into these large central veins was associated with higher infection rates as well as other complications like pneumothorax (a condition where air escapes into the space outside the lung). In contrast, PICC line problems are low in frequency.

A PICC line is first placed by a health care provider into a large peripheral arm vein and is guided up into a larger vein towards your heart. Local anesthesia may be used. The outer end is then stitched in place and covered with a sterile gauze bandage. Correct placement is verified through an x-ray. The procedure takes about one-and-a-half hours with most patients feeling little discomfort during the procedure.

Benefits of PICC Line

•      PICC lines can be used for many weeks/ months, as needed, even at home

•      Low risk of infection

•      Useful for hydration purposes, blood transfusion, nutrition, and medications like antibiotics or chemotherapy

•      Useful for repeated blood tests

•      Low risk for irritation or damage to blood vessels due to repeated blood extractions, IV insertions, or IV medicines.

Are There PICC Line Complications?

During insertion of PICC line, complications may include:

• Slight discomfort during insertion of the introducer needle into a vein
• Inability to insert the catheter due to vein scars or partly clotted veins
• Need to insert the catheter in the other arm, if the doctor/nurse fails to insert in the first arm
• Punctured blood vessel
• Nerve or tendon damage
• Irregular heartbeat, if the catheter was placed too far into your heart

After placement, PICC line risks include:

• Catheter dislodgment, if the PICC line is not properly secured, or if you suddenly move
• Vein clotting or deep vein thrombosis
• Vein inflammation or phlebitis
• Air embolism
• Infection at the site of insertion site
• Infection in your bloodstream
• Breaking off a piece of the catheter, which may travel in the bloodstream (catheter migration)
• Catheter damage catheter
• Superior vena cava syndrome

How to Avoid PICC Line Complications

• To avoid the complications,you must perform a daily inspection of your PICC line dressing and insertion site. Be sure that your dressing is always dry and clean and regularly changed.
• Contact your healthcare provider if you experience pain, redness, swelling or drainage on the skin, or if you have fever with chills. These may be symptoms of infection and must be treated immediately.
• Watch out for signs of occlusion, which includes slow infusion of fluids and inability to flush the line. Make sure that there are no kinks or clamps in the line. Contact your nurse if simple troubleshooting cannot resolve PICC line problems.
• Report any swelling in your face, neck, chest or arm, as swell as pain in your arm. These may signal a deep vein thrombosis in your arm or superior vena cava syndrome. Although rare, it can occur and it needs immediate intervention.
• Call emergency services immediately if you experience signs of air embolism, which include rapid heartbeat or heart palpitations, coughing, and difficulty breathing. While waiting for help, lie down on your left side with your feet elevated.
• Call your nurse immediately if you suspect catheter dislodgment, damage, or migration. Other signs that must be reported immediately include leaking at the site of insertion, swelling, burning pain during infusion, "ear gurgling", headache, swelling, redness/pain in your neck, shoulder, or arm, or wet dressings.

How Is PICC Line Inserted?

1. A nurse finds a suitable vein in your upper arm while being guided by ultrasound.
2. To prevent infection, your arm is cleaned and covered with sterile cloth.
3. A tourniquet is applied around your arm.
4. Local anesthesia is injected to numb the site of insertion.
5. A small needle is placed into a vein, followed by the insertion of the introducer needle, which serves to guide the PICC line towards your heart.
6. A chest x-ray is done after placement to make sure that the catheter is properly placed.
7. The PICC line in sutured in place.
8. The insertion site is covered with a sterile dressing and pressure bandage.
9. Your dressing should be inspected and changed regularly (about twice a week).

PICC Line Flush and Care

Remove

Always wash your hands before inspecting, cleaning, changing bandages or flushing your PICC line. Put on gloves, and if necessary, a face mask. To change your bandage, gently remove the used one and throw directly into the trash, together with your gloves. Put on a new pair of gloves and inspect the catheter insertion site for skin redness, pain, swelling, bleeding, fluid, or pus. Call your caregiver if you observe any of these changes.

Clean

Clean the skin area around the catheter with a recommended solution from your nurse. Avoid pulling or moving your catheter. Let your skin dry before putting on a new bandage. Secure the bandage with tape around the gauze edges. Remove your gloves and throw in the trash bag. Finally, wash your hands.

Flush

Using a syringe, you will also need to flush or push a small amount of liquid through your catheter. Flushing helps avoid PICC line complications due to blockage. It also prevents medications from mixing together in the tubing. Flush your catheter:

• Before administering a medicine.
• After administering a medicine.
• Once daily, if you use the PICC line often.
• Once a week only, if you do not use the PICC line often.

You can flush your PICC line using either saline solution or heparin, which prevents blood clot formation. Your nurse will teach you how to flush your catheter properly:

• After washing your hands, put on a pair of medical gloves.
• Clean the end of the PICC tubing.
• Attach the syringe filled with flushing solution onto the end of the tubing.
• Slowly push the plunger of the syringe to push the fluid into the catheter. Avoid forcing the plunger in if it is difficult to push. Look for any kinking in the tubing that may be causing the PICC line problems. Straighten the kinks. If there are no kinks, your catheter may be blocked. Ask your caregiver to evaluate the problem.
• After you are able to push the solution, slowly pull out the syringe. Dispose   syringes properly. Clean the end of the catheter. Remove and throw away your gloves, then wash your hands.