Indications
PICC lines are used when a patient is in need of total parenteral nutrition (TPN), long-term antibiotics, IV fluid support, and delivery of chronic medications. Since these catheters are not tunneled, which means that they enter the vein shorty after entering the skin, they are typically used for a shorter amount of time than a tunneled catheter. However, they can be used for several months-years if needed. We are able to place a number of different catheter types made of different materials in order to accommodate the individual needs of our patients.
Procedural Details
The placement of a non-tunneled PICC is done with local anesthesia to ensure that the patients are comfortable throughout the procedure; IV sedation can be provided if needed. The procedure begins with gaining access into a suitable vein in the body. The vein that is used is typically a vein in the upper arm, above the elbow. Ultrasound guidance is used to place a small needle into the target vein. Once the needle is placed into that vein, a guidewire is advanced further into the vein to maintain position within the vein. The PICC is then advanced over the guidewire and positioned with its tip right near the heart. We determine the exact position of the PICC tip using x-rays. Once the catheter is appropriately positioned, we place some stitches to help hold the catheter to the skin. Following the procedure, you will spend <1 hour in our recovery area.
Post-Procedure Care
It is important to take care of a catheter after it is placed so that it can continue to work for as long as it is needed. The exit site for the catheter as well as the dressing over the catheter should be kept clean and dry. Patients can take a bath, but the catheter should be kept covered and dry.
It is possible that over time, clot can form inside the catheter or immediately outside the catheter. If this occurs, it may be difficult to draw blood or receive treatment through the catheter. This is usually treated by putting clot-dissolving medication called tissue plasminogen activator (tPA) directly inside the catheter. Another potential cause for diminished blood through a catheter is something called a fibrin sheath. As the body adapts to the catheter being present, a small film of tissue may form inside the body over the tip of the catheter. This can interfere with blood flow and may also be treated with clot-dissolving medication. At times, the presence of a fibrin sheath may require the catheter to be changed.
If the area around a catheter feels sore or looks red, it is possible that it may represent an infection of the catheter. This may especially be the case if there is fever, chills, or drainage from the catheter exit site. An antibiotic ointment may be used if the infection is limited to the catheter exit site. If there is drainage from the exit site or if the infection has spread throughout the body, antibiotics may be required.