Peripherally Inserted Central Catheter (PICC)

PICC is like any other tube used to access the large veins of your body. This catheter is used in IV or intravenous therapy for giving blood products or medicines, fluid or nutrition to your body, especially when needed for a long time, usually for 6-8 weeks. This is especially useful when small intravenous cannulas cannot be be placed in your hand or forearm veins. It can also be used to withdraw blood from the body.

Any patient requiring blood products, medicines, fluid or nutrition for a prolonged time and on a regular bases will benefit from this. Also patients requiring long term antibiotics or chemotherapy can also use PICC for that purpose. PICC usage is painless and stress free. Patients facing intravenous cannula issues or difficult IV cannulation of veins are also advised to go for PICC.

Basically for long term access, a central vein needs to be accessed. Other possible lines/catheters available include:

• Central Line: placed directly into your neck veins/central vein. However, it has issues with respect to comfort and have a higher chances of infection. Also life span is around 2-3 weeks, and requires changing. More so, generally patients cannot be discharged home with a central line and it is generally placed while the patient is admitted in the hospital.
• Chemo-pot/Port/Port-catheter: These are ports or small residual chambers placed under the skin of your chest, generally for chemotherapy. Ports require a Cath Lab-OT for insertion and are an excellent option for long term chemotherapy.
• Intravenous Cannula: Placed in the veins of your arm/hand. Issues include: they cannot be used for long term and generally get blocked within a few days, cannot be used for blood collection and have a high chance of thrombophlebitis and local infection compared to PICC.

• Firstly, it shall be made certain that you are the correct candidate for a PICC placement. Written informed consent will be taken.
• Before the procedure starts the doctor examines the area and make sure there is no local infection on your skin in the arm or forearm. Shaving of parts may be done.
• An ultrasound may be done to make sure that the veins are patent. After examining the doctor will choose the appropriate vein in your arm.
• Usually the order of preference is the right arm over the left since the right vein course is shorter. For right handed persons, this may be cumbersome and left hand may be used. It sometimes depends on the anatomy of your body and the status of your veins.
• Mostly, the superficial veins i.e. the basilic or cephalic vein is chosen. Rarely, a deeper vein i.e. the brachial vein may be used. After examination, then the skin is clean with the cleansing solution.
• Local anesthesia is given to the patient to numb the area making sure the patient feel zero pain throughout the procedure.
• With the help of USG image guidance, a special small needle is inserted into the chosen vein. With the access achieved with needle a guided wires is put into the vein.
• Now, over the wire with the full access kit, the catheter is advanced over the guided wires till it reaches the central venous system. The success of this procedure depends on the right placement of the catheter to achieve the access of the vein.
• Using X-ray or fluoroscopy the right placement of the catheter is decided. The tip of the catheter should be rightly located in the superior vena cava to achieve the desire results. Good forward and back flow is needed in the PICC line for adequate usage.
• Once the catheter is placed, sutures are taken to fix the PICC. Special adhesive strips are placed. It helps in the placement as well as to avoid displacement.
• To protect the insertion area from any sort of infection, sterile dressing is applied on it. Regular dressing change is practiced for best results.

Benefits

• Easy use: With PICC inserted, there is no repeat needle sticks required for blood sample collection. In cases where blood samples are required on a regular basis, PICC can be used.
• Cases where medication or fluids are to be given to the patient on a regular bases, PICC can be used. This reduces pain, discomfort and stress of the patient. PICC is therefore a cost effective solution.
• Access: The best  part of PICC is the ease of access. PICC can be accessed from the arm/forearm itself with no pain.
• PICC can be used for long term access.
• Can be used at home itself.

Risks

No procedure can be risk free or without complications/side effects. These include:

• Infection: Small risk of infection is always a possibility with an invasive procedure. Fever due to line/catheter insertion warrants removal.
• There is always a small possibility of the formation of blood clot around the catheter leading to venous thrombosis.
• Misplacement or PICC catheter breakage/fracture.
• PICC blockage: Clot formation or fibrin sheath at catheter tip. This may warrant change or removal of PICC.

• Keep the dressing dry.
• Avoid excessive touching or handling with bare hands.
• PICC dressing change is to be done in a sterile manner by a trained staffed.
• To avoid blockage, after usage, PICC should be flushed with Heparin.
• Keep the PICC line clamped.
• Don’t let blood or clot develop in the dead space.
• Visit your doctor in case of fever, arm swelling, facial swelling, breathlessness or if there is no backflow in the PICC.