Peripherally Inserted Central Catheter (PICC)

What is a PICC?

PICC is short for Peripherally Inserted Central Catheter. A PICC is a special intravenous (IV) line.

A PICC is a long, soft, thin, flexible tube that is inserted into a vein in the arm and ends in a large vein just above the heart. For babies, a PICC might be put into a vein in the leg instead.

PICC

A peripherally inserted central catheter (PICC or PIC line) is used for patients who need long-term frequent IV therapy. It is inserted into a vein of the arm and ends in a large vein above the heart.

A PICC is used in some children who need IV therapy for a long period of time. IV therapy means medicine that is put into the vein. Frequent needle insertions can be painful and can damage children's veins, so a PICC may be the best way for some children to receive medicines and IV fluids or to have blood samples taken.

An interventional radiologist or a nurse will insert your child’s PICC in the Image Guided Therapy (IGT) department. An interventional radiologist is a doctor who use special viewing equipment such as X-rays, ultrasound, or computed tomography (CT) scans to perform procedures that may have required traditional surgery in the past.

Before the procedure

Before the procedure, the doctor or nurse inserting the PICC will meet with you to explain the procedure, answer your questions, and get your consent.

If your child will be receiving a general anaesthetic (sleep medicine), you will also meet with the anaesthetist before the PICC insertion. This is the doctor who will give your child the sleep medicine.

Talk to your child about the procedure

Before any procedure, it is important to talk to your child about what will happen in a way that she will understand. Children feel less anxious when they know what to expect. It is important to be honest. If you are not sure how to answer your child’s questions, ask the Child Life Specialist on your unit for help.

Blood tests

Your child may need blood tests before coming for the procedure. This is for your child’s safety. Your child’s doctor will arrange this.

Food and fluids before sedation or general anaesthetic

Depending on your child’s age and medical condition, she might be awake during the procedure, slightly sedated (relaxed), or under a general anaesthetic, which will make her fall asleep. The doctor will know what type of anaesthetic is best for your child.

Your child’s stomach must be empty during and after the sedation or anaesthetic. This means your child is less likely to throw up or choke.

What your child can eat and drink before the sleep medicine (sedation or general anaesthetic) Time before procedure What you need to know Midnight before the procedure No more solid food. This also means no gum or candy. Your child can still drink liquids such as milk, orange juice, and clear liquids. Clear liquids are anything you can see through, such as apple juice, ginger ale, or water. Your child can also eat Jell-O or popsicles. 6 hours No more milk, formula, or liquids you cannot see through, such as milk, orange juice, and cola. 4 hours Stop breastfeeding your baby. 2 hours No more clear liquids. This means no more apple juice, water, ginger ale, Jell-O, or popsicles. If you were given more instructions about eating and drinking, write them down here:

How a PICC is inserted

During the procedure, the tip of the PICC will be positioned in a large vein just above the heart, where the blood flow is fast. This placement allows for better mixing of medicines and IV fluids.

Equipment such as ultrasound and fluoroscopy (a special X-ray machine) may be used during the procedure. A chest X-ray may be taken after the procedure to make sure the PICC is in the right position.

It will take about 30 to 60 minutes to insert a PICC. If it is hard to find a good vein, it may take longer.

During the procedure, you will be asked to wait in the waiting area. When the procedure is over and your child starts to wake up, you may see your child. Once the PICC is inserted, the doctor or nurse will come out and talk with you about the procedure.

Pain relief during and after the procedure

For many children, the PICC will be inserted with only a local anaesthetic. Local anaesthetic is medicine to numb the area of the arm where the PICC will be inserted. This medicine is sometimes given by a needle into the skin, which may sting a little. Once the medicine has had time to work, your child should not feel any pain.

Sometimes, children are given sedation or a general anaesthetic.

• A general anaesthetic means that your child will be asleep and will not have any pain during the procedure.
• If your child receives sedation, she may fall asleep or just be very sleepy during the procedure. Often, your child will not remember everything that happened during the procedure. Your child will be given a local anaesthetic as well.

After the PICC is put in, children may feel pain in a small area on their arm. Usually this pain is mild and will go away within a few hours. If your child complains of a lot of pain, ask your nurse or doctor if she can have something to relieve the pain.

Children often try to guard the arm that has the PICC. Encourage your child to use her arm normally. It is good and safe for your child to move the arm in all directions.

When your child can go home

Some children can have a PICC placed and go home the same day. They may be ready to go home right away. Some children need to stay in the hospital for a few hours for observation (to be watched). This will depend on how much sedation was used.

Children who are not discharged home will go back to their hospital room. The nurse can start using the PICC as soon as it is needed.

Risks of inserting a PICC

Any procedure carries some risk. Every procedure is judged by weighing the benefit for your child against the risk it may pose. Procedures vary from low risk to high risk, up to and including death.

A PICC insertion is usually considered low risk. The risks of the procedure will vary depending on the condition of your child, the age and size of your child, and any other problems she may have.

The risks of any central catheter insertion, including a PICC, can include:

• failure to find an open vein that will accept the PICC
• bleeding or bruising
• infection
• clotting
• air in the lungs or veins
• rupture (breakage) of a blood vessel
• abnormal heart rhythm
• breakage of the catheter
• death (very, very rare)

How to care for the PICC

The area where the PICC comes out of the skin will be covered with a clear bandage. This bandage is sterile. This means that it is put on in a special way to keep the site as germ-free as possible. The PICC can be used right away for your child’s medicine or fluids.

While you are in the hospital, the nurses will look after your child’s PICC. To prevent the PICC from becoming infected, the nurses will change the bandages and caps when needed, using sterile equipment.

When your child goes home, a Community Care Nurse will look after your child’s PICC. As you become more comfortable caring for the PICC, the nurse can teach you how to provide some of this care yourself.

To prevent the PICC from becoming blocked so that it will work well every time your child needs IV medicines or fluids, the PICC will always have one of the following:

• An infusion, where fluids are passed through tubing and a pump.
• A heparin lock. Heparin is a medicine that helps to prevent the PICC from becoming blocked. New heparin will be flushed into the PICC after each use. If the PICC is not being used each day, the heparin flush will be done every 24 hours.

Always keep the PICC dry. If the PICC gets wet, it is more likely to become infected. Your nurse will teach you how to cover the PICC to keep it dry when your child bathes. If the bandage gets wet, change it right away.

Protect the PICC

The PICC is not attached inside your child's body, so if it is pulled, it can come out. It is very important to make sure the PICC is always taped in a looped position and covered with a bandage. Make sure that the gauze wrapped around the end of the PICC is taped to your child’s arm, or onto the chest if your child is small. This prevents it from being accidentally pulled.

Keeping the PICC taped well to your child’s body will also prevent it from twisting or kinking. This very important to prevent it from becoming damaged or broken.

Activities

After the PICC is inserted, your child will be able to go back to most activities. This includes going to day care or school. Tell your child’s caregivers or teachers about the PICC.

Your child may also be able to play some sports and games, such as riding her bike. It is important for your child to do as many usual activities as possible. There are a few things that your child should not do:

• Your child should not do water sports or swimming. If the bandage gets wet, it is more likely to get infected. If the bandage gets wet, change it right away.
• Your child should not play sports that might result in a hit to the PICC or cause the catheter to be pulled out, such as hockey, football, gymnastics, or basketball.
• Do not use scissors anywhere near the PICC. No one, including you, your child, a nurse, or a doctor, should be allowed to use scissors near the PICC. This will prevent it from being cut.
• Do not let other children touch or play with the PICC.

What to look out for after the PICC insertion

Contact your Community Care Nurse, the Vascular Access Service at the hospital, or your doctor or clinic nurse if you see any of the following:

• your child has fever or chills
• your child has bleeding, redness, or swelling around the PICC
• your child has leaking or drainage at the PICC site
• your child’s PICC is hard to flush or will not flush at all
• your child has pain when the PICC is being used
• your child’s PICC is dislodged or comes out a little or all the way

Each child’s situation is different, so you should also ask your doctor if there are any specific instructions for your child. Write them here:

 

What to do if the PICC breaks

Before you leave the hospital, you will be given a PICC Emergency Kit. The kit contains the supplies you will need if your child’s PICC breaks. A nurse will give you the kit and review it with you before you leave. You should always make sure that the kit is with your child in case the PICC is ever broken.

If the PICC breaks, do the following:

1. Stay calm. Clamp the PICC between the break and your child.
2. Clean the broken area with a chlorhexidine swab.
3. Place clean gauze under the broken area and tape the PICC to the gauze. Wrap the gauze around the catheter, then tape this gauze roll to your child’s chest.
4. If the hole is small, you should try to heparinize the PICC (if you have been taught how) to help prevent it from becoming blocked.
5. Call the Vascular Access Service as soon as you have done this for further instructions. You will be asked to bring your child to the hospital for assessment.

Some PICCs can be repaired without having to be replaced. Some broken PICCs will need to be removed.

What to do if the cap falls off

If the cap falls off, get supplies from the PICC Emergency Kit and follow these steps:

1. Wash your hands.
2. Wipe the hub of the PICC with a chlorhexidine swab.
3. Take a new cap from the kit and screw it onto the end of the PICC. Wrap and tape gauze around the end of the PICC.
4. Tape the gauze to your child’s arm.
5. The cap must be changed as soon as possible, using the sterile technique. You can do this if you have been taught, or your Community Care Nurse can do it.

How long the PICC can stay in

A PICC can stay in for weeks or months.

Removing the PICC

Once your medical team is confident that the PICC is no longer needed, they will make arrangements for the PICC to be removed. This procedure is fairly simple and takes about 5 to 10 minutes. Sometimes, a cream will be used to numb the skin around the PICC, or a local anaesthetic medicine will be injected into the skin before the nurse or doctor removes the PICC. Sometimes, depending on the type of PICC your child has or how long it has been in, there is no need to use any local anaesthetic. Your child will not need any type of sedation.

Things you should know about your child’s PICC

It is important that you know a few facts about your child’s PICC. If you have a problem and have to call the Community Care Nurse or Vascular Access Service, it will be helpful to give them the following information about your child’s PICC as well as information about the problem. Complete the following information.

Date of insertion:

Catheter type:

Size (circle one that applies):

• single lumen
• double lumen
• triple lumen
• cuffed
• uncuffed

Catheter used for (circle all that apply):

• antibiotics
• blood products
• chemotherapy
• medicines
• blood sampling
• TPN
• other:

Notes about the PICC:

 

Questions or concerns

If you have any questions or concerns about your child’s PICC, you can call one of the following people. Write the numbers here:

Community Care Nurse:

Vascular Access Service:

Your child’s doctor or nurse:

Other:

Key points

• PICC is short for Peripherally Inserted Central Catheter. A PICC is a long, soft, thin, flexible tube that is inserted into a vein in the arm and ends in a large vein just above the heart. For babies, a PICC might be inserted into a vein in the leg.
• A PICC may be the best way for some children to receive medicines and IV fluids or to have blood samples taken
• Your child will be given pain medicine so she will not feel any pain during the procedure.
• A nurse will teach you how to take care of your child's PICC, including what to do if it breaks or the cap falls off.

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