Peripherally inserted central catheters (PICCs)

PICCs are used in many different situations. Some patients may need a PICC to avoid having needles put into their arms every time they need treatment or a blood test. Others need a PICC because of the type of treatment they are having, or to help reduce the amount of time they spend in hospital.

If you are unsure why you are being offered a PICC, please speak to the team looking after you or one of the central venous access nurses.

We are a team of nurses who specialise in intravenous lines (lines situated within a vein), including PICCs. We will put in your PICC and provide expert advice before and after your PICC insertion. Please feel free to ring us on 020 3447 7491 if you have any questions.

An alternative would be a tunnelled line (sometimes called a Hickman line) or an implantable port. Your doctor or nurse may have suggested a PICC for you but if you would like more information about these alternatives, please talk to the team looking after you or one of the central venous access nurses.

Leaflets about these lines are also available on our website: uclh.nhs.uk/cvc

If possible, please try to drink plenty of fluids before your appointment as this will make it
easier to put the PICC in.

You may need to have a blood test before your PICC appointment. Your doctor or nurse will arrange this for you if necessary.
If you take tablets or injections to thin your blood, these may need to be stopped for a short time. This is to prevent any bleeding during the PICC insertion. Your doctor or nurse will explain this to you in detail.

If you have ever had an infection called MRSA, please let your doctor or nurse know. You may need to have a nose swab to see if the infection is still present before your PICC can be put in.

We want to involve you in all the decisions about your care and treatment. The team looking after you will answer any questions you may have so please ask if anything is unclear.

If you decide to go ahead, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

One of the central venous access nurses will usually insert your PICC. To reduce the risk of infection, the nurse will wear a surgical gown with a hat and mask. She/he will use ultrasound to find a vein in your upper arm and inject local anaesthetic into the skin to numb it. This will cause some temporary discomfort but once the skin is numb you won’t feel the PICC being threaded up through your vein.

To guide the PICC into position the nurse will use a heart monitor. This technique is called ‘ECG tip location’ and your nurse will explain it to you in detail. Once the PICC is in, the nurse will insert a tiny anchoring device and a special dressing to keep the line in place. Occasionally there are difficulties in accessing a vein or threading the PICC into position. If this happens, your nurse will probably try again using a different vein.

It usually takes about half an hour to put the PICC in, but you should allow two hours for the appointment. This is because it will take time to check you in and prepare equipment. The nurse putting in your PICC will also need to talk it over with you beforehand.

If you are an inpatient, you will be taken back to the ward. If you are an outpatient, you will be able to go home on the same day.

If needed, the PICC can be used straight after it has been put in.

A PICC can stay in for several weeks or months. One of the nurses on the ward or in day care will remove it when you no longer need it. Removal of the PICC itself does not hurt but some patients experience discomfort when the anchoring device is taken out. If this happens, ask the nurse to give you an injection of local anaesthetic to numb the skin.

Infection

It is possible for an infection to develop in the skin around the PICC or in the bloodstream. Contact your nursing or medical team, or one of the central venous access nurses, as soon as you can if you experience any of the following symptoms:

• a high temperature (over 38°C)
• feeling shivery
• redness or discharge where the PICC was inserted.

If you have an infection, you will need to take a course of antibiotics and your PICC may need to be removed.

Blood clot

It’s possible for a blood clot (thrombosis) to form in the vein used for the PICC. This happens in between two and six out of 100 patients who have a PICC and are also receiving chemotherapy. To help to prevent a clot, try to use your arm normally and drink plenty of fluids while your PICC is in place.

If you notice swelling or pain in the shoulder, neck or arm on the same side as the PICC, contact your nursing or medical team, or one of the central venous access nurses, as soon as possible.

If you have a clot, you will need medication to dissolve it. The PICC can often stay in place. There is also a small risk of a blood clot on the lungs. This is very rare. If you experience chest pain or sudden shortness of breath, go to your local Emergency Department (A&E), or call an ambulance.

Heart palpitations

PICCs can sometimes cause heart palpitations which feel like a fluttering in the chest or a pounding heart. Palpitations are unlikely to cause you any harm but might mean that the PICC is too far in. If you have palpitations, let us know and we can pull the line out by a centimetre or two. This is a simple and painless procedure.

PICC moving out of place

There is a small risk that the PICC can be accidentally pulled out. Every time your PICC is used, its external part should be measured to check this has not happened. It is also possible for the PICC to move out of place inside your body. This is not painful but it might stop the PICC from working. If it does happen, the PICC will need to be replaced. 

Blockage

PICCs can sometimes become blocked. We can usually unblock them by using a special flushing solution. Occasionally if this fails, the PICC will need to be removed.

Breakage

On rare occasions the PICC may develop a leak. If this happens, the PICC will have to be removed.

Damage to nerves and arteries

Very rarely, the nerves or arteries in your arm can become damaged. If it did happen, it could cause long-term pain or numbness in your hand or arm, which may need surgical repair. 

This will depend on the type of treatment you are having. You should discuss your options with your doctor or nurse, or contact the central venous access team on 020 3447 7491 if you have any concerns. 

You will be able to use your arm normally while the PICC is in but it’s important that you keep the dressing dry. We will give you a special plastic sleeve to put on when you have a shower or a bath. Swimming is not recommended.

The dressing over the PICC will need to be changed and the PICC flushed weekly. Flushing helps to stop the PICC from getting blocked. It is a painless procedure where a syringe is attached to the PICC and fluid is flushed into it.

If you are going home with your PICC in, the chemotherapy or ward nurses may refer you to the district nurses for your PICC care. Or you can make an appointment to have it done in the Supportive Care Unit on the fourth floor of the Macmillan Cancer Centre.

Some patients prefer their partner, a family member or a close friend to care for their PICC. If this is something you would like, please talk to one of the central venous access nurses.

While your PICC is in place, contact your nursing or medical team, or one of the central venous access nurses, if you notice any of the following:

• a high temperature (over 38°C)
• feeling shivery
• a sore or swollen arm
• unusual heartbeat
• your PICC becoming displaced.

Central venous access team: Monday to Friday, 9am to 5pm, Telephone: 020 3447 7491
Supportive Care Unit: Monday to Friday, 8am to 8pm, Telephone: 020 3447 1808
Out of hours: Oncology patients: 07947 959 020, Haematology patients: 07852 220 900, Teenagers and young adults: 07908 468 555