Your doctor may have talked to you about using a device called a peripherally inserted central catheter (PICC). This fact sheet explains how and why they are used.
What is a PICC and how is it different from a cannula?
A cannula or “drip” is a short, thin plastic tube inserted into a small vein that sits just under the skin. No metal needle remains inside. Medications and fluids are delivered through a cannula.
A PICC is a longer version of a cannula. It is inserted into a small vein in the arm or leg and then gently moved forward until the tip of the PICC is in a big vein close to the heart. PICCs are usually able to remain in these big veins. They may remain in place for many months if required by the treating medical team unlike cannulas, which often need to be changed. A PICC is a type of central line.
Why would my child need a PICC?
- Certain medications
- Small/difficult veins
- Parenteral Nutrition
- Long term treatment
How is the PICC inserted?
- Most children need to be asleep to help them keep still for the procedure. This usually means having a general anaesthetic.
- The PICC is inserted by a doctor who has been specially trained.
- The procedure is done in an operating theatre to reduce the risk of infection.
- Local anaesthetic may be injected into the surrounding area to numb the area and reduce pain. PICCs are not usually painful after they are inserted.
- The PICC is always covered by a dressing to keep it clean and safe. They are also kept in place using a securement device.
- An X-ray is done after the PICC has been inserted in the operating theatre. This is to make sure the tip of the PICC is in the correct position and safe to use. Sometimes dye is also injected into the PICC to make it easier to see on an X-ray.
Potential challenges with inserting the PICC
- If your child’s veins are very small, it may be too difficult to insert the PICC. Your doctor may discuss other options to PICCs. These may include a central venous catheter (CVC) inserted into a big vein in the neck. This will be done by an interventional radiologist, anaesthetist or surgeon.
- The position of the PICC may not be satisfactory on the X-ray and it may need to be repositioned.
How is it removed?
Removal of a PICC is done as soon as it is no longer needed (such as once treatment is complete), or not functioning well (such as an unresolved complication or infection). All staff removing PICCs have special training to do it safely. The line is simply pulled out once all the dressings have been removed on the ward. General anaesthesia is not necessary.
What is ‘flushing’ and ‘locking’?
- ‘Flushing’ of the PICC occurs when a normal saline (salt water) solution is injected in the line to prevent it from blocking. This is typically done after medications have been given.
- ‘Locking’ refers to when a solution made out of anti-blood clotting agent (heparin or citrate) and sometimes an added antibacterial agent (taurolidine/Taurolock) is left in the line when it is not being used. This is typically done when the PICC does not need to be used for up to one week.
Below is a list of complications for PICCs. These are listed for your information, but not all patients experience a complication, and serious complications are rare.
As with any procedure there is a risk of infection, although we do our best to avoid this by making sure everything is clean and sterile in the operating theatre.
- Signs to look for include redness, pain, heat and swelling over the site or the limb where the PICC is inserted.
- Your child might also have a fever or feel unwell. Your child also needs to present to their closest Emergency Department if they have a temperature of 38oC or more as the PICC is a possible source of infection.
- If the PICC is thought to be the reason for the infection then the line may need to be removed and your child given antibiotics.
Damage to the catheter
The part of the PICC that is outside the body may become damaged with a split or crack.
- You may notice some fluid ooze from the line or under the dressing.
- If this happens, the line may need to be removed.
- There is a risk of bleeding or oozing around the insertion site. This usually settles down within the first day or two after insertion.
The PICC may be pulled out accidentally.
- If this occurs, pressure should be applied over the insertion site and medical staff informed immediately. If at home call 000.
- If present, any fluid or medication running through the line should be stopped and the line should be clamped.
The most common complication of PICCs is blockage of the line.
- This occurs because blood or medication gets stuck in the line.
- PICCs will either have fluid running through them or be locked (see previous page) to try to prevent this from happening.
- A blocked line can sometimes be fixed by flushing. Sometimes the line is too blocked and needs to be removed.
Air bubbles or ‘air embolus’
There is a small risk of air bubbles entering the line.
- We make sure that there is no air in the syringes used to inject into the line.
- If there is a break or a leak in the line it is important to clamp it immediately to prevent air from entering. If damaged the PICC will be removed.
Very rarely there can be serious complications.
- The PICC could damage or puncture the wall of blood vessels or of the heart.
- A serious infection or blood clot could also develop.
- These complications are extremely rare, but can be life threatening.
- It is important that your doctor discuss these possible complications with you, as well as all the risks and benefits of the PICC before you provide your consent (approval) for the procedure to go ahead.
Serious complications are rare. If you are worried, please feel free to talk to your team doctor or the doctor who is inserting the PICC.
(Write down any question or concerns you would like to ask the doctor/nurse)