A Peripherally Inserted Central Catheter, commonly called a PICC line, is a thin, flexible tube used to deliver medications, fluids, or nutrients directly into the body’s central circulation. Inserted into a peripheral vein in the arm, the tip extends to a large vein near the heart, providing stable, long-term access. PICC lines are used for therapies requiring prolonged intravenous access, such as long courses of antibiotics, chemotherapy, or total parenteral nutrition. They are a less invasive alternative to other central lines, reducing the need for repeated needle sticks.
Defining Physical Length and Placement
The physical length of a PICC line is customized to the individual patient’s anatomy. During the insertion procedure, a healthcare provider measures the distance from the intended insertion site on the arm to the final destination near the heart. The catheter is then trimmed to this precise measurement to ensure proper placement.
The insertion typically occurs in a large vein in the upper arm, such as the basilic or cephalic vein, which gives the line its “peripherally inserted” designation. The catheter tip must rest in the lower third of the superior vena cava, a major vein leading to the heart. This central location allows administered medications to be rapidly diluted by the high volume of blood flow, protecting the surrounding vessel walls from damage.
Standard Duration of Use
The primary advantage of a PICC line is its suitability for medium to long-term therapies. Unlike standard peripheral intravenous lines that require replacement every few days, a PICC line is designed to remain in place for the entire course of treatment. This longevity often spans from six weeks up to six months, and in some cases, even longer, depending on the patient’s needs.
PICC lines are appropriate when intravenous therapy is expected to last 15 days or more. For treatments lasting beyond three to six months, providers may consider transitioning to other devices, such as tunneled catheters or implanted ports, though PICC lines can safely exceed this timeframe with proper maintenance. The decision to keep the line is based on the ongoing necessity of the therapy and the absence of complications. Regular review ensures the device is removed promptly once the medical need is met.
Factors Influencing Removal Timing
While PICC lines are designed for extended use, several factors can necessitate their removal sooner or sometimes later than the standard duration. The most common reason for removal is the completion of the prescribed therapy, such as finishing a six-week course of intravenous antibiotics. However, complications can require premature removal, with mechanical issues and infections being the most frequent concerns.
Complications often require premature removal:
- Infection at the insertion site or a bloodstream infection mandates immediate removal.
- Mechanical problems, such as catheter occlusion (blockage), fracture, or migration.
- The development of venous thrombosis (a blood clot in the arm vein).
Daily Care and Maintenance
Longevity of the PICC line is tied to proper care and maintenance, which aims to prevent infection and maintain patency. The insertion site must be covered with a sterile dressing, typically changed once a week by a trained healthcare professional. This sterile procedure uses an antiseptic solution, such as chlorhexidine, to clean the skin and reduce microbial entry.
Flushing the catheter is routine to prevent clotting and blockage. If the line is not in active use, it is flushed with a saline solution at least once a week. If the PICC line is used for infusions, flushing must occur immediately after each use to ensure the line remains open. Patients must also avoid activities that could dislodge or damage the line, such as submerging the arm in water, heavy lifting, or carrying objects in the arm crease.