PICC insertion: Caring for your child at home after the procedure

Your child has had a peripherally inserted central catheter (PICC) insertion. The information on this page explains how to look after your child at home after the procedure, and when to call for help. When your child goes home, a home-care nurse will take care of your child’s PICC and can teach you how to provide some of this care yourself.

Discharge from the hospital

How much time your child stays in the hospital depends on the reason for the PICC insertion and on how your child is feeling after the procedure. Some children who have a PICC go home on the same day as their procedure. Others remain in the hospital to receive additional treatment.

Dressings after the procedure

The area where the PICC comes out of the skin will be covered with a clear bandage. This bandage is put on in a special way to keep the site as clean as possible.

The PICC can be used right away for your child’s medication or fluids. Your child should not feel any pain when the PICC is being used.

Pain relief after the procedure

After the procedure, some children may feel pain in the small area where the PICC comes out of the skin. Usually, this pain is mild and will go away within a few hours. If needed, give your child acetaminophen for pain. If your child complains of a lot of pain, call your child’s nurse or doctor and ask if your child can have something to relieve the pain.

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

Complications may occur with your child’s PICC. It may break, the cap may fall off, the dressing can come loose or the PICC can fall out. Broken PICCs will need to be removed and replaced. It is important that you are prepared to handle these situations.

Other possible complications include clotting of the PICC, blood in the catheter or cap, and infection. Remember to wash your hands before handling the PICC.

Catheter damage

Catheter damage can happen from rough handling, pulling, cutting with scissors, general wear and tear, or puncturing with a sharp object. If this happens, fluid may leak out of the catheter at the damaged point, germs can get inside, and blood may back up into the catheter. You may notice that the catheter is wet if there is a small tear in the line.

What to do if the PICC breaks or leaks

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 the kit is with your child.

If the PICC breaks, do the following:

1. Stay calm.
2. Clamp the PICC between the break and your child using the padded clamp that has been provided. If you do not have a clamp, bend the line over and tape it together.
3. Stop the infusion if your child has one running.
4. Clean the broken area with an alcohol swab.
5. Place clean gauze under the broken area and tape the PICC to the gauze.
6. Wrap the gauze around the catheter, then tape this gauze roll to your child’s arm.
7. If the hole is small, and you have been taught how, you should try to heparinize the PICC to help prevent it from becoming blocked.
8. Call the Vascular Access Service as soon as you have secured the PICC for further instructions. You will be asked to bring your child to the hospital for further assessment.
9. Bring the broken line with you. This is the fastest way of knowing the correct size.

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

What to do if the cap falls off

If the cap falls off:

1. Wipe the end of the PICC with an alcohol swab.
2. Take a new cap and place it on the end of the line by screwing it onto the hub.
3. Wrap clean gauze around the cap and then tape the gauze to your child’s arm.
4. Have the cap changed as soon as possible. You can perform the cap change using aseptic non-touch technique (ANTT), if you have been taught, or the home-care nurse can do it.

What to do if the dressing comes loose

1. If the dressing comes loose, reinforce it with tape.
2. If the dressing comes off, secure the line with a new clean dressing.
3. As soon as possible, a new dressing needs to be applied. You can perform the dressing change using ANTT, if you have been taught, or the home-care nurse can do it.

What to do if the PICC falls out

If the catheter falls out or gets pulled out:

1. To stop the bleeding, apply pressure for 10 minutes to the site where the catheter enters the vein in the child’s arm.
2. Clean the exit site with the usual cleaning solution, and apply a bandage over the area.
3. Observe the entry site for any swelling or bruising.
4. Contact a member of your health-care team for further instructions. The procedure to re-insert the PICC may not be possible right away.

What to do if there is blood visible in the catheter or cap

There may be blood visible in the catheter or cap if there is an increase in pressure in the chest veins from crying, laughing, exercising or leaving the clamp open while the pump is turned off. It will also happen if there is an opening anywhere along the system, such as a loose connection or defective cap.

If blood appears in the catheter, you should flush it and then heparinize it, if you have been taught how to do so. If you see blood, always check the system for leaks, cracks and loose connections. Replace any parts that are replaceable, and re-check for blood back-up. Let the health-care team know if you cannot fix the problem.

What to do if you cannot flush the PICC

Most PICCs have clots or sludge build-up. If you notice gradually increasing pressure when flushing the PICC, there may be particles sticking to the inside walls of the PICC, making the pathway for fluids narrower. If you are suddenly not able to flush the PICC, check that the clamp is open and that the PICC is not bent or twisted. If it is not one of these things, the PICC may have a clot stopping the flow of fluids. You must call a member of your health-care team if this happens.

Never try to flush a clot out of the PICC. You may burst the PICC or push a clot into your child’s heart and lungs. If you find a complete blockage while trying to flush the PICC, report this to your health-care team. You will need to come to the hospital or clinic for help.

Infection

Having a PICC gives bacteria an easy route into the blood system. Therefore, there is a risk of infection every time you handle the line. The aseptic non-touch technique (ANTT) during PICC care is the most important way to prevent an infection. The catheter exit site must be cleaned and dressed properly to prevent the growth of germs. Getting the supplies dirty or wet, or not following the methods of ANTT could allow germs to enter and grow in the body, which could cause a serious infection.

If your child develops a fever of one degree above their normal temperature or has chills or sweats, call a member of your health-care team right away. Not all fevers mean that there is an infection in the PICC; but infection is always suspected, and the PICC needs to be looked at.

Before you call:

• Check to see if your child has any other signs of infection, such as a sore throat, cough, runny nose, sleepiness or any change in behaviour.
• Look at the PICC exit site to see if there is any redness, swelling or discharge.

For secondary caregivers

The video below will show family members, teachers, daycare providers and other caregivers how to manage the emergency procedures for a PICC. Review this video with anyone who is caring for your child in case they will need to perform any of these procedures.

Caring for your child at home with a PICC

There must always be a bandage over the PICC exit site on the arm. This bandage keeps the PICC clean and secure. The end of the catheter, called the hub, will be closed with a cap.

When you go home, a home-care nurse will care for 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, it will always have one of the following:

• An infusion, where fluids are being pushed into the PICC through a pump.
• A heparin lock. Heparin is a medication that helps prevent the PICC from becoming blocked when there is no fluid infusing into it. 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.

Protecting the PICC

Although the PICC is quite secure, it is not attached to anything 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 secured to your child’s arm. This helps to prevent it from being accidentally pulled out. Keeping the PICC taped to your child’s arm will also prevent it from twisting or kinking. This is important to prevent it from becoming damaged or broken.

Dressing care

The area where the PICC comes out of the skin will be covered with a clear bandage. There must always be a bandage over the PICC exit site on the arm. This bandage keeps the PICC clean and secure.

• It is normal to have some dry blood on the dressing after the insertion. There should be no active bleeding at the PICC site. If there is, contact the Vascular Access Resource Service.
• Leave the dressing in place.
• Do not wet the dressing. If the PICC gets wet, it can become infected.
• A home-care nurse will change the dressing weekly, or as often as needed. This should be arranged by your referring doctor before you leave the hospital.
• Do not remove the little stitch at the site of the PICC insertion. It will fall out on its own after a few weeks.
• Make sure the PICC is always secured to your child’s arm to prevent it from twisting or kinking.

Bathing

Your child may shower or take a bath 24 hours after the PICC is inserted. However, it is important to always keep the PICC and the dressing dry. If it does get wet, the dressing should be changed immediately. Your child’s nurse will teach you how to cover the PICC to keep it dry when your child bathes.

Meals

If your child received sedation or anaesthetic and is feeling well enough after the procedure, they can return to eating what they normally eat. It is also important to encourage your child to drink plenty of fluids for 48 hours after the procedure.

Pain relief

If needed, give your child acetaminophen for pain. Do not give your child any medicines that will thin the blood, such as acetylsalicylic acid (ASA) or ibuprofen, without checking with a nurse or your child's doctor first.

Activity

Your child can resume gentle activities 24 hours after the PICC is inserted, as long as they are not experiencing any pain. 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. The PICC should not be put under water, so your child should not play water sports or swim at any time. Never allow the use of scissors anywhere near the PICC, and do not let other children touch or play with the PICC.

When to see a doctor

Call your child’s doctor or go to the nearest Emergency Department right away if your child has any of the following:

• A fever greater than 38°C (100.4°F), or over the normal range provided by your doctors or nurses
• Pain requiring acetaminophen after 48 hours
• Bleeding that does not stop with pressure
• Leakage or drainage at the PICC site
• Difficulty breathing
• A funny feeling in their heart
• Noticeable swelling in the face, chest, neck or arm on the side where the PICC line is located
• The PICC gets pulled out a little or all the way

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

What to do if you have concerns

If your child is a SickKids patient, you can contact the Vascular Access Resource Nurse Monday to Friday during business hours with questions or concerns via phone (416-813-6986) or email (vascularaccess.resourcenurse@sickkids.ca).

On weekends/after hours, you may need to go to the nearest Emergency Department for alternate methods for fluid/medication delivery if the line is blocked or broken.