A Peripherally Inserted Central Catheter (PICC line) is a thin tube inserted through a vein in the upper arm, with its tip resting near the heart. This placement allows for the long-term delivery of medications, nutrients, or fluids directly into the bloodstream. Managing this device at home requires careful attention to medical protocols to ensure its safety and function. Proper home care minimizes the risk of serious complications, such as infection or blockage, allowing necessary therapy outside of a hospital setting.
Daily Site Protection and Hygiene
Maintaining the cleanliness and dryness of the PICC insertion site is essential to prevent bacteria from entering the bloodstream. The transparent dressing covering the site must be kept clean, dry, and securely adhered to the skin at all times. If the dressing becomes loose, wet, or soiled, it must be changed immediately, even if it is not the scheduled change day.
When showering, the PICC site must be completely covered with a waterproof material, such as plastic wrap, to prevent moisture from reaching the dressing. Keep the arm with the line away from the direct spray of water. Avoid activities that cause friction, tension, or kinking of the catheter, including heavy lifting (more than 10 pounds). Vigorous arm movements and contact sports are discouraged to prevent accidental dislodgement or damage. Complete submersion in water, including swimming, hot tubs, or baths, is strictly prohibited due to the high risk of contamination.
Essential Steps for Dressing and Cap Changes
The dressing and the needleless connector cap must be changed using a sterile process to prevent infection. This procedure is typically performed once a week or whenever the dressing is compromised. Before beginning, gather all supplies on a clean, flat surface, and everyone involved must wear a mask.
The first step is meticulous hand hygiene, washing hands thoroughly with soap and water for at least 30 seconds. After putting on clean gloves, gently peel off the old dressing, moving slowly and low to the skin to avoid pulling the catheter. Once the old dressing and any securement device are removed, discard the gloves and clean hands again before putting on sterile gloves.
The insertion site is cleaned with a specialized antiseptic, such as chlorhexidine solution, using a back-and-forth motion for at least 30 seconds. The antiseptic must be allowed to air dry completely for the recommended time, usually three minutes, before applying the new dressing. This drying time is crucial for the antiseptic to be effective. The new transparent dressing is then applied over the site, ensuring the securement device and insertion point are fully covered.
Changing the Connector Cap
Changing the needleless connector cap involves clamping the catheter. Scrub the connection point vigorously with an antiseptic wipe for 15 seconds and allow it to dry. The old cap is then twisted off and the new, sterile cap is twisted on firmly. Take care not to touch the exposed catheter end or the connecting side of the new cap. This process uses an aseptic non-touch technique to maintain a sterile barrier.
Maintaining Patency: Flushing the PICC Line
Internal maintenance of the PICC line involves regular flushing to ensure patency and prevent blood clots, which can lead to occlusion. Occlusion is a blockage that can make the catheter unusable and may necessitate its removal. Flushing typically uses sterile normal saline, and sometimes a small volume of heparinized saline is used afterward, depending on the specific medical order.
The syringe containing the flushing solution must be prepared by removing any air bubbles before connecting it to the needleless connector cap. Before connecting, the cap must be vigorously scrubbed with an alcohol or chlorhexidine wipe for at least 15 seconds to disinfect the surface. Once the clamp is opened, the flushing solution is injected using the “push-pause” technique, which involves pushing a small amount of fluid, pausing briefly for one to two seconds, and then pushing more fluid.
This push-pause method creates turbulence inside the catheter lumen, which helps to dislodge any fibrin or medication residue. The recommended volume of flush, often 3 to 10 milliliters, should be injected smoothly without applying excessive force. If resistance is felt when pushing the plunger, stop immediately and never force the fluid, as this could damage the line. The line should be clamped just before the syringe is completely empty to maintain positive pressure within the catheter, preventing blood from flowing back into the tip.
Recognizing and Responding to Potential Complications
Vigilance for signs of complications is an important part of home care, as early recognition allows for prompt medical intervention.
An infection at the insertion site often presents with localized symptoms such as increasing redness, warmth, swelling, or pain. Systemic signs of a widespread infection include fever and chills.
Catheter occlusion, or blockage, is indicated by the inability to easily flush the line or difficulty withdrawing blood. If an infusion pump alarms or if resistance is met during flushing, a partial or total occlusion may be present.
Catheter migration or displacement may be signaled by a noticeable change in the external length of the catheter. Migration can also cause discomfort in the upper arm, shoulder, jaw, or chest during infusions. If any of these signs occur, contact the healthcare provider immediately for guidance. Never attempt to force a flush or push a dislodged catheter back into the skin.