Peripherally inserted central catheters (PICCs) are venous access devices used to administer all types of intravenous medications and solutions.  PICCs are soft, flexible catheters about the size of a piece of spaghetti.  They are inserted by specially trained nurses, physicians, physician assistants, nurse practitioners, or radiological technologists.  PICCs are used in all care centers and allow patients to have one access device for the full length of therapy.

The popularity of PICCs has increased related to the ease of insertion through the veins of the arm, the low risk associated with them, and their low cost of insertion.  As with all central lines, PICCs require x-ray confirmation immediately after placement and prior to administration of medication.  Successful terminal tip location is the distal portion of the superior vena cava.

PICCs can be used for just about any therapy. This type of catheter comes in single, double or triple lumen (channel) designs. Like all catheters, no matter how many lumens, there is still only one entrance site (the place where the PICC is actually inserted into your vein) and exit site (the place where it comes out of your skin). You will see the PICC exit the skin near the vein in which it is placed. There will be a small segment of the PICC with a cap on the outside of your skin. This is how your infusions will be connected. Compared with other CVADs, PICCs can be easy and quick to place, as there is no tunnel or surgical pocket to create. No incision is required for a PICC, only a puncture into the vein. In addition, PICCs may have fewer complications than other CVADs.

Although most people need PICCs for only a few weeks or months, PICCs can last for years if taken care of properly. They are relatively small and flexible, so most people find them comfortable. However, because there is an external segment, all PICCs require regular flushing and dressing changes. Your doctor or healthcare provider should give you specific instructions about care, maintenance and any activity limitations. PICCs usually do not require any special procedure for removal. They slide out like a regular Intravenous (IV) catheter. A nurse can remove them in your doctor’s office or at home.

“Blockages” in a PICC
There are common reasons for PICCs to become blocked. Contact your doctor or nurse who can help overcome most of these problems. Here are a few common reasons for blockages:

• Blood clots in the blood vessel around your PICC can cause blockage. Clots can plug up the catheter making infusions difficult. Sometimes you can infuse your medicines but are unable to get blood out. This may be caused by a fibrin sheath, which is tissue your body may deposit on the catheter. Both of these problems can be treated with “clotbusting” drugs given through the PICC which help dissolve the clot or sheath. Sometimes, the catheter may need replacement or other methods need to be used to restore catheter function (including angioplasty, or “ballooning”).
• Mechanical blockages or malpositions, can occur when a catheter is in the wrong place in a blood vessel, is kinked or pinched, or is broken. This could also happen if your CVAD has accidentally come out part of the way or been pushed in too far. Sometimes the catheter can be repositioned to restore function.
• Residue or “precipitate” build-up inside the PICC is another cause of blockage. This can occur if medications interact with one another, if they leave behind a residue, or if your PICC is not flushed properly. Sometimes solutions can be injected into your PICC to dissolve the residue. A blood clot can plug up the catheter, making infusion difficult.

Infection

Infections are caused by germs getting in or around a PICC and can become a serious problem if not treated promptly.

Make sure to check daily for:

• Redness, swelling, warmth, tenderness or drainage where the PICC enters or exits your body. You may have a “local” infection.
• Fever, chills, vomiting, diarrhea, fatigue, weakness and loss of appetite can be signs that there is an infection in your bloodstream. If any of these occur, you should contact your doctor or nurse immediately.

Phlebitis
Inflammation of the vein, called “phlebitis,” can occur if the tissue or blood vessel near the PICC gets irritated or damaged. This can be a response to a foreign body in the
PICC or to the medicine or fluids being given through the PICC. Notify your doctor or nurse if you have redness, swelling, pain, hardness or warmth near the CVAD.

PICC Tip Movement
It is possible that the tip (the deepest portion) of your PICC can change position within your body. This can happen if you have excessive vomiting, coughing, sneezing or hiccupping, or vigorous arm movement.

Notify your doctor or nurse if you have any pain or discomfort near your PICC or in the shoulder, jaw, ear or neck, or if you have a feeling of coldness or fullness in the area. If you hear flushing or have pain when your PICC is used, tell your nurse or doctor. Check your PICC to make sure the section outside your body does not seem longer than usual. If it does seem longer, it may have partially come out of the vein where it is inserted. Secure the CVAD with a dressing, and call your doctor or nurse immediately for help.

External Catheter Breakage
It is rare for your catheter to break or tear, but it can happen. Catheter breakage can be caused by using sharp objects around the catheter, twisting or bending the catheter when changing caps, using excessive force when flushing, or catching the external part of the catheter (e.g., on clothing) resulting in the catheter being pulled or stretched.

Here are some simple steps to decrease the likelihood of catheter breakage:

• Never use less than a 10 cc syringe, and do not use excessive force when flushing.
  
• Avoid using sharp objects such as scissors near the catheter.
  
• Avoid twisting or kinking the catheter.
  
• Secure all external parts of the catheter so nothing is dangling free.

If your catheter does break, you may see that your dressing is wet, that fluid leaks out when you flush or that some blood is leaking out of the catheter. If the catheter is broken, immediately place a clamp above the break, close to your skin (after the catheter is placed, ask your nurse or doctor for an extra clamp to use in an emergency), and call your nurse or doctor. Some catheters can be repaired, while others may need to be removed and replaced.

Internal Catheter Breakage
Internal catheter breaks are very rare, and when they do occur, the catheter will need to be removed and replaced.

If your catheter breaks on the inside, you may notice that your catheter is not working correctly. You may also notice that your heart rate is a little faster or beating irregularly, and you may feel shortness of breath for no obvious reason. Call your nurse or doctor immediately for instruction.

 

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