What is a PICC?
A peripherally inserted central catheter (PICC) is a type of intravenous (IV) line. A PICC is a long, soft, thin, flexible tube that is inserted into a vein in the arm and guided through the veins until it is positioned in a large vein just above the heart. For babies, a PICC might be put into a vein in the leg instead.
Why is a PICC inserted?
A PICC is used in some children who need IV therapy for a long period of time. IV therapy can include IV medications, nutrition and fluids. Having a PICC inserted makes it easier and more comfortable for your child to receive these IV therapies. If your child has a PICC inserted to receive IV therapies, it can also often be used to take blood samples and to provide total parental nutrition (TPN).
How is a PICC inserted?
A PICC is inserted using image guidance by an interventional radiologist. A needle is inserted into a vein in the arm with the assistance of ultrasound and an X-ray called fluoroscopy. Using fluoroscopy, the PICC is guided into the vein until the tip is positioned in the large vein just above the heart. This placement allows for better mixing of medicines and IV fluids.
PICC lines are usually inserted in the right arm but can be put into any limb. A chest X-ray may be taken after the procedure to make sure the PICC is in the correct position.
Risks of a PICC insertion for your child
A PICC insertion is usually considered a low-risk procedure. The risks of the procedure will vary depending on your child’s condition, age and health.
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
- pain or discomfort
- infection
- clotting
- air in the lungs or veins
- irregular heart rhythm
- breakage of the catheter
- movement of the catheter
- X-ray exposure
- vein perforation
- nerve or artery damage
Preparing for a PICC insertion
If your child is already in the hospital, you will meet a nurse from the Vascular Access Service who will explain the procedure and answer your questions. If your child is an outpatient, the health-care team looking after your child will explain the procedure to you.
If your child requires a general anesthetic for the PICC insertion, you will meet the anesthesiologist before the procedure. This is the health-care provider who will give your child medicine to sleep during the procedure.
Giving consent before the procedure
Before the procedure, a member of the interventional radiology team will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh the benefits against them. It is important that you understand all these potential risks and benefits of the PICC insertion and that all your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to them to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
Food, drink, and medicines before the procedure
- Your child’s stomach must be empty prior and during sedation or anesthetic.
- If your child has special needs during fasting, talk to their health-care provider to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their health-care provider and the interventional radiologist.
On the day of the PICC insertion
Your child will have medicine for pain
It is important that your child is as comfortable as possible for the procedure. Depending on your child’s age and medical condition, they might be awake during the procedure, slightly sedated (relaxed) or receive general anesthesia.
Many children only receive a local anesthetic when the PICC is inserted. Local anesthetic is medication that numbs the area of the arm where the PICC will be inserted. This medication is usually given by a needle into the skin. Once the medication has had time to work, your child should not feel any pain.
Sometimes, children are given sedation or a general anesthetic.
- If your child receives sedation, they may fall asleep or be sleepy during the procedure. Often, your child will not remember everything that happened during the procedure. Your child will be given a local anesthetic as well.
- If your child receives general anesthetic, they will not hear or feel anything during the procedure.
During the procedure, you will be asked to wait in the waiting area.
After the PICC insertion
Once the PICC is inserted, the doctor, someone from the health-care team will come and speak with you about the details of the procedure.
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.
Helping your child
Please see PICC insertion: Caring for your child at home after the procedure to learn how to properly care for your child at home after a PICC insertion.
How long can the PICC stay in?
A PICC can stay in for weeks or months, as long as it remains problem-free and working well.
Removing the PICC
Once your child's health-care team is confident that the PICC is no longer needed, they will plan for the PICC to be removed. This procedure is simple and takes about five to 10 minutes. Sometimes, a cream will be used to numb the skin around the PICC, or a local anesthetic will be injected into the skin before the PICC is removed. Depending on the type of PICC your child has, or how long it has been in, there is sometimes no need to use any local anesthetic. Your child will not need any type of sedation.
When to seek medical assistance
Call your child’s health-care provider 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 child’s health-care team
- 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 child’s health-care provider if there are any specific instructions for your child.
At SickKids
At SickKids, the interventional radiologists work in the Department of Diagnostic Imaging – Division of Image Guided Therapy (IGT). You can call and speak to the IGT Vascular Access Service Resource Nurse at (416) 813-6986 during working hours or leave a message with the IGT Vascular Access Team. If you have concerns and it is after working hours, please call The Hospital for Sick Children switchboard at 416-813-7500 and ask them to page your child’s health-care provider on call or go to the nearest Emergency Department.
For more information on preparing your child for their procedure, see Coming for surgery.