A peripherally inserted central catheter (PICC), also called a PICC line, is a tube inserted into a vein in an extremity, most commonly the arm, and leads directly to the heart. PICC lines can be used in patients with chronic conditions that require recurrent medications. Individuals who experience an acute illness or infection that is severe enough to require intensive treatment and medication administration through a vein may need to have a PICC.
These types of central catheters are often left in place for an extended period of time, such as with long-term antibiotic use or fluid replacement. They deliver medications to large veins near the heart, where they are then transported through the circulatory system to the rest of the body. This type of central line is also beneficial for avoiding multiple IV placements and maintaining the integrity of the veins when repeated venous access is necessary.
It is very important that a PICC line is properly cared for to ensure the health and safety of the individual. Lets discuss what measures should be taken to ensure the PICC functions properly, what complications to watch for, and when to receive medical attention.
Measuring The PICC
A key point to discuss regarding a PICC line is its placement. This can be assessed by noting the measurements found directly on the catheter. For reference, the PICC line has measurements printed on the catheter at different intervals.
When a PICC is first placed, notice which interval is at the insertion point. Nursing personnel should regularly document this measurement to ensure that it maintains appropriate placement. This will help avoid a PICC line being pulled out and help maintain the proper function of the PICC.
PICC Maintenance
For a central line to be viable and usable, it must remain patent and be routinely flushed. Flushing refers to clearing the line of any medication. It is extremely important that medications do not stay in the tubing and that all of the medication is transferred into the bloodstream.
Flushing the PICC incorrectly or not at all can result in only a partial dose of medication being delivered to the patient. It can also result in a clotted line that causes many issues and can be challenging to fix. To prevent a PICC from clotting while not in use, heparin-infused saline is used before locking the line. Maintaining a patent PICC will ensure proper medication administration and the integrity of the catheter.
Protecting the PICC
A central line, such as a PICC line, must be protected to maintain viability. It is best practice to wrap the external portion of the PICC close to your extremity. An exposed catheter can be easily dislodged or pulled out if it is accessible. Avoid any activities that would put the PICC in danger or could compromise it. This could include contact sports or activities in close physical proximity to others.
Take caution when showering or bathing that the catheter and insertion site are not exposed to water. Water can compromise the dressing and potentially introduce contaminated water into the body.
What are the Potential Complications?
Proper dressing care is mandatory to protect the individual and their central line. Dressings must remain clean and dry. Dirt or moisture creates the perfect environment for bacteria to thrive and reproduce, causing major concerns for the individuals safety and well-being. If the dressing is lifting or compromised, foreign material and bacteria can enter, and the dressing must be replaced.
Routine dressing changes are necessary to provide a clean environment under the dressing. A trained healthcare provider must perform all dressing changes using the sterile technique. Take note of any tears, cracks, or kinks in the catheter. A healthcare provider should address these to ensure the tube's integrity is intact; if not, the PICC may need to be replaced.
What to Watch For: Infections and Air Embolisms
Two of the major complications of a PICC are infections and air embolisms. Both complications are very serious and, if not addressed immediately, can potentially lead to death. Knowing how these complications occur and how to prevent them is pertinent.
Infection Prevention Is Crucial
An infection can be contracted at multiple points when using and caring for a PICC. Because of this, the PICC must be assessed frequently and thoroughly, dressing changes must be performed using a sterile technique, and safe medication administration must be practiced. Examples of how infections can occur in a PICC line include but are not limited to:
- Bacteria can enter under a poorly kept dressing or if a dressing change is done incorrectly.
- Proper steps are not taken during medication administration, and bacteria are transferred from the syringe or medical personnels hands to the PICC.
- Bacteria enter the PICC through a crack in the catheter and then enter the bloodstream.
- Improper hand hygiene or not using or maintaining sterile technique when doing a dressing change can lead to bacteria transferring from an individuals hands to the central line.
When no medication or fluids are being infused through the PICC, a cap must be placed at the end of the catheter to prevent bacteria from entering the line. If bacteria are present at the end of the PICC, they can be flushed into the bloodstream.
Signs of Infection
Watching for signs of infection is necessary when caring for a central line. Due to a PICC having direct access to the bloodstream, infections must be prevented to ensure safety and avoid serious complications such as sepsis. Signs of infection to monitor for include:
- Redness
- Swelling
- Pain
- Irritation
These symptoms can be present at the insertion site but can also migrate up the extremity as they worsen. Fever, muscle aches, fatigue, and chills can indicate a systemic infection potentially introduced through the central line. Signs of a worsening infection may include confusion, altered level of consciousness, and changes in vital signs. Any signs of infection need to be addressed by a healthcare provider immediately.
Air embolisms
A severe and life-threatening potential complication of PICC lines is an air embolism. This occurs when air enters the catheter and is introduced into the bloodstream, and it can lead to a pulmonary embolism.
A pulmonary embolism occurs when an air embolism travels through the blood and lodges in the lungs, blocking blood flow. Without immediate medical attention, it can be fatal.
Take precautions when administering medications to avoid an air embolism. Ensure no air is present in the line or in the syringe before administration. Proper technique when removing a PICC line is also needed to avoid an air embolism upon removal.
Signs of a pulmonary embolism can include:
- Shortness of breath
- Difficulty breathing
- Cyanosis
- Chest pain
- Coughing up blood
Emergency medical care must be sought if you experience these symptoms.
Communicate with Your Healthcare Team
Because of the sensitive nature of a PICC line and its open channel to the bloodstream, it is essential to watch for any complications or problems with a PICC. Any issues or worries should be communicated with your healthcare team. If you experience any chest pain or breathing issues, call 911 immediately.
Conclusion
A peripherally inserted central catheter (PICC) is a beneficial option when treating individuals with various diagnoses. Its direct access to the bloodstream and long-term accessibility make it very useful, and it can streamline medication administration for those with both chronic and acute diagnoses or infections.
It is pertinent that a PICC is properly cared for and maintained, that safe medication administration occurs, and that routine assessment is performed. Awareness of signs of infection or an air embolism can help prevent severe complications. If any questions or concerns arise, reach out to your healthcare team for direction and guidance.
About Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
If you want to learn more about CEUfasts Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.
