What Is a PICC Line?

A peripherally inserted central catheter gives access to the bloodstream

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A PICC line, or peripherally inserted central catheter (also sometimes called a percutaneous inserted central catheter), is a medical device that allows ongoing access to the bloodstream for up to six months at a time. It can be used to deliver intravenous (IV) fluids or medications, such as antibiotics or chemotherapy, and to draw blood or perform blood transfusions.

Pronounced “pick,” the line is commonly inserted through a vein in the upper arm and then threaded to a large central vein near the heart.

Most facilities only allow a standard IV to remain in place three to four days before it is removed and a new one is placed. Over the course of many weeks, a PICC can substantially reduce the number of times you have to tolerate the poke of an IV being inserted into a vein.

Like a standard IV, a PICC line allows the medication to be infused into the bloodstream, but the PICC is more reliable and more durable. It can also be used to give larger volumes of fluids and medications that are too irritating to the tissue to be given through a standard IV.

Home healthcare nurse tending to picc line of recovering patient
Jodi Jacobson / Getty Images 

Uses

A PICC line can be used for a variety of purposes when it is expected that a person will need to receive IV medication for prolonged periods. A PICC line may be recommended for the following treatments:

  • Antibiotics or antifungals: Serious bacterial or fungal infections may require daily IV medications for several weeks or more.
  • Cancer treatments: Medications administered through a vein, especially chemotherapy drugs that are considered caustic, can be diluted in the bloodstream faster with a PICC than via a standard IV.
  • Liquid nutrition (total parenteral nutrition): Liquid nutrition may be given daily through a vein in those with difficulty eating or absorbing nutrients.
  • Heart medications: Medications given continuously, such as drugs used for congestive heart failure, can be given via a PICC or other types of central lines.

In addition, people might need a PICC line in the following situations:

  • Need for multiple IV medications: A PICC line can have multiple ports, allowing medications to be given simultaneously without mixing. This can be helpful for medications that may irritate small veins or would otherwise require separate IV sites.
  • A "hard stick": A PICC line may be used if you are considered a "hard stick," meaning the healthcare team finds it difficult to place an IV even with repeated attempts.
  • Frequent blood draws: PICC lines can be useful for drawing blood repeatedly, especially if you do not tolerate blood draws well yet require ongoing monitoring through blood tests.

Process

The PICC line itself is a tube with a guidewire inside to stiffen the tube to make it easier to thread into the vein. The PICC line may be trimmed to a shorter length if necessary, especially if you are petite. The ideal length allows the line to extend from the insertion site to where the tip rests in a blood vessel outside the heart.

PICC lines are typically placed by nurses (RN), physician assistants (PA), or nurse practitioners (NP). The procedure, which takes about an hour, is typically done bedside in hospitals or long-term care facilities, or it can be an outpatient procedure.

A vein is selected, and the insertion site is typically numbed with an injection. The area is cleaned thoroughly and a small incision is made to access the vein.

Using sterile technique, the PICC line is gently inserted into the vessel. It is slowly advanced into the blood vessel, where it goes up the arm and then makes its way toward the heart. In many cases, sonography (ultrasound) is used to identify the best site for PICC placement, which can reduce the number of times you get "stuck" during placement of the line.

Once the PICC is in the appropriate place, it can be secured to the skin outside of the insertion site. Most PICC lines are sutured in place, meaning that the tubing and port that rests outside of the skin is held in place by stitches. This prevents the PICC from moving or being removed accidentally.

Once the PICC is in place, an X-ray is performed to determine if the line is in the appropriate place in the blood vessel. If it is not in the appropriate place, it may be pushed further into the body or pulled back slightly.

Once the placement is confirmed, the guidewire is removed and the line is safe to use.

Risks

PICC lines carry some risks of complications, including those that are serious and potentially life threatening. If there is a complication with a PICC line, it may need to be removed or adjusted, or additional treatments may be required.

Complications can include:

  • Infection: An infection may form at the insertion site, an event that is more likely the longer the PICC line remains in place.
  • Blood clots: Blood clots can form on the tip of the PICC line. If these clots break free, they can travel through the heart to the lung, a condition called a pulmonary embolism (PE). They can also form in the arm around the line and may cause vein inflammation.
  • Malfunction: PICC lines can become clogged. Medications are available to try to clear the line, but this not always effective and may result in the removal of the line.
  • Irritation of the heart: If the line is too close to the heart, or in the heart, it can irritate the heart and cause a cardiac arrhythmia, an abnormal heart rhythm. If the problem is not diagnosed quickly, the PICC line rubbing against the beating heart can cause damage to the heart muscle or valves.

Warnings

Seek urgent medical care if you have any of the following signs or symptoms with a PICC line:

  • The port won’t flush or infuse
  • The PICC leaks
  • The PICC moves, and the part outside the skin is suddenly longer than it used to be (some PICC tubing has numbers that are visible and work as a visual guide)
  • Arm or chest pain
  • Soreness, redness, or swelling around the PICC line
  • Fever
  • Shortness of breath
  • Coughing
  • Changes in heartbeat, such as heart palpitations

Safety

PICC lines require regular maintenance, including routine sterile dressing changes, flushing with sterile fluid, and cleaning of the ports. Preventing infection is key, which means keeping the site clean, keeping the bandage in good condition, and washing your hands prior to touching the ports.

If a dressing change is needed before a scheduled dressing change (unless you change it yourself), promptly contact your healthcare provider.

Your healthcare provider will also let you know what activities and movements to avoid, such as heavy lifting or contact sports.

You will need to cover their PICC site with plastic wrap or a waterproof bandage for showering. You should not get your PICC site wet, so swimming or submerging your arm in a bath is not advised.

Removal

Removal of a PICC line is quick and typically painless. The sutures holding the line in the appropriate place are removed, and the line is gently pulled from the arm. Most patients say that it feels strange to have it removed, but it is not uncomfortable or painful.

Once the PICC is out, the end of the line is inspected. It should look the same as it did when it was inserted, with no missing pieces that could potentially be left inside the body.

A small bandage may be placed over the site if bleeding is present, and it will remain in place for two or three days while the wound heals.

A Word From Verywell

While PICC lines can sometimes have complications, the potential benefits usually exceed the risks and they're a reliable way to deliver medications and monitor health conditions. Once a PICC line is in place, you will not have to deal with the irritation or sensitivity of repeated needle pokes in order to receive treatments or have blood drawn for testing.

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Article Sources
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  2. McDiarmid S, Scrivens N, Carrier M, et al. Outcomes in a nurse-led peripherally inserted central catheter program: A retrospective cohort study. CMAJ Open. 2017;5(3):E535-E539. doi:10.9778/cmajo.20170010

  3. Centers for Disease Control and Prevention. Frequently asked questions about catheters. Updated May 9, 2019.

  4. Zarbock A, Rosenberger P. Risks associated with peripherally inserted central catheters. Lancet. 2013;382(9902):1399-1400. doi:10.1016/S0140-6736(13)62207-2

  5. Centers for Disease Control and Prevention. Central-line associated bloodstream infections: Resources for patients and healthcare providers. Updated February 7, 2011.

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