This information explains what a PICC line is, what to expect on the day it is inserted, how to care for it, what to look out for, and includes useful contact numbers.

What is a PICC line?

A PICC line (also called a Power PICC or Central line) is a long, hollow tube inserted into a vein in your upper arm and guided up the vein until it reaches large vein above your heart. It is used to give treatments such as:

• Chemotherapy
• Antibiotics
• Intravenous fluids
• Blood samples
• X‑ray dye for CT scans

Why do I need a PICC line?

You require a PICC line for one of the following reasons:

• The type of treatment your doctor has prescribed for you can only be given through a PICC line.
• The treatment you need must be given through a special pump.
• Following previous treatment you have had, the veins in your arms or back of your hands may be sore.

Will I need tests before the PICC line goes in?

A blood test will be carried out before insertion.

What about my medications?

There are some medications that we will need to know about in advance, but we will check these with you. In particular we need to know if you are on blood thinning medication. On the day of insertion, a blood test will be taken to check how thin your blood is before the PICC line is inserted. You may be asked to stop temporarily your medications for a few days prior to PICC insertion.

We will tell you when to start the medications again.

These are some of the medications that you may be asked to stop temporarily:

• Apixaban
• Acenocoumarol
• Clopidogrel (Plavix)
• Cilostazol (Pletal)
• Heparin / Enoxaparin
• Dabigatran
• Phenindione
• Rivaroxaban
• Warfarin

This list is subject to change, and your nursing and medical team will advise you.

Is there anything else I need to tell the nurse?

You need to inform us if you have a cardiac pacemaker in place, or if you have had any infections in the past such as MRSA, C Difficile or other infectious diarrhoea.

Who puts the PICC line in?

A specially trained nurse will put in your PICC line.

Where do I go to have my PICC line placed?

The procedure will usually be performed in Laurel House Chemotherapy Unit, Antrim Area Hospital.

Will it hurt?

You will get an anaesthetic injection to numb the area before the PICC line is inserted. Some patients feel nothing and others feel a slight scratch or pressure.

Can I eat and drink as normal?

You may eat breakfast or have a light lunch. You can drink as normal.

What do I need to wear?

You can wear your normal everyday clothes. Loose and short sleeves will help. We will ask you to remove any jewellery from your neck. Women will be asked to remove their bra before the procedure.

Can I drive home after the PICC line has been inserted?

No, it is best that someone drives you to and from the hospital. You will experience heaviness in your arm after the procedure due to the local anaesthetic used.

What happens on the day of my appointment?

Your appointment may take up to 4 hours. We will explain the procedure to you and tell you about anything you should be aware about afterwards. You will be given the opportunity to ask questions and clarify all the details around the procedure. We will then ask you to sign a consent form.

The PICC line insertion

You will be lying on a bed during the PICC line insertion. Sterile drapes are used to cover you and the area where your arm is resting. This is to ensure everything is kept as clean as possible.

The nurse will wear appropriate Personal Protective Equipment when placing your PICC line such as a gown, gloves, face mask, goggles or visor.

To make the procedure as painless as possible you are given a small injection to numb the skin at the area the PICC line is inserted.

Your PICC line will be inserted with the help of an ultrasound machine. This enables the nurse to guide the PICC line into place.

The nurse will utilise a special device that will provide additional information to guide the PICC line into the correct position.

Following insertion, you may get an x-ray to check the position.

How does the PICC line stay in place?

It will be kept in place by a plastic clip which attaches to the PICC line to secure it. This remains in place for the entire time the PICC line is required. However, if you have a nickel allergy, an alternative will be used. The PICC line is not stitched in place.

Is it possible that the nurse will not be able to put my PICC line in?

Sometimes the nurse is unable to successfully insert the PICC line. This can happen for many reasons. These include:

• Difficulty getting into your vein
• Your vein may be too narrow for the PICC line to travel up your arm
• Your vein may have been scarred by previous needles or treatments preventing insertion
• Previous surgery or injury to the shoulder, neck or chest area.

If we cannot place your PICC line your doctor may decide to change your treatment or use another type of central line.

What problems could happen with the PICC line?

The specialist nurse will discuss the possible complications in more detail before you sign your consent form.

Possible complications include:

• Infection
• Formation of a blood clot (Thrombosis)
• Blocked line (Occlusion)
• Movement of the line (Migration)
• Bleeding
• Damage to the line
• Temporary nerve pain

What should I look out for whilst my PICC line is in place?

If you notice any of the following you need to contact the 24hr Chemotherapy and Haematology Helpline on 0771 1989 914 without delay.

• Feeling ‘shivery’ or unwell after the PICC line has been flushed
• Any redness or pain around the insertion site or top of arm
• Bleeding in or around where the PICC line enters your arm
• Fluid leaking around the skin where the PICC line enters your arm
• Swelling of your arm, neck or shoulder
• The part of the PICC line you can see looks shorter or longer
• Your skin feels sore or uncomfortable under the dressing

Care of my PICC line

Laurel House staff will refer you to the District Nursing team who will care for your PICC line.

If required, the District Nurse may check your PICC line 24 hours following insertion.

Your PICC line will be dressed and flushed weekly or if the dressing becomes soiled or damp.

What you are required to do:

• It is essential to report any problems as soon as possible to the 24hr telephone helpline.
• You should use your arm normally but not excessively. This is important to reduce the risk of some complications.
• Keep a record of when your PICC line has been flushed and dressed.
• Always bring your PICC line record card to your appointments and have it available for the district nurse on each home visit.

What about showering or bathing?

You can still have a bath or shower, but you will need to keep the PICC line dry. This is very important as it can cause the dressing to loosen or introduce an infection.

The water level in a bath should not be above waist height.

Wrap your arm in cling film when showering or bathing. You will be given a request for a prescription for a waterproof sleeve to take to your GP.

Are there any activities that I shouldn’t do with a PICC line in my arm?

You can carry on with most of your normal activities when you have a PICC line in place, but there are some things you need to avoid.

You should not swim, weight-lift, play golf or carry very heavy items e.g. children. Activities such as these may cause your PICC line to move. Avoid excessive or repetitive movements.

What happens if I go to another hospital?

You should bring your PICC line record with you to all hospital or treatment room appointments and if you attend the X-ray department for a CT scan.

How long does my PICC line stay in?

Your PICC line will stay in until your treatment has finished, as long as it is working well. It is important that your PICC line is removed after it is no longer required.

How to contact us

It is vital if you have any questions or problems with your PICC line, please contact us.

Oncology and Haematology Triage Helpline

• Telephone: 0771 1989 914