A PICC line is a type of intravenous (IV) access device, but it is fundamentally different from the standard IV placed in a hand or arm. Both devices deliver fluids and medications directly into the bloodstream. The primary difference lies in where the tip of the catheter ultimately rests inside the body and the purpose for which it is used.
Defining Vascular Access: PICC Lines vs. Peripheral IVs
The standard IV, known as a peripheral intravenous catheter (PIV), is a short, small-gauge tube inserted into a minor vein, typically in the hand or forearm. The tip of this catheter stays within the peripheral vein, and the device is intended for short-term use, usually lasting only a few days before needing replacement.
A PICC line (Peripherally Inserted Central Catheter) is a much longer, thinner tube inserted into a peripheral vein in the upper arm, such as the basilic or cephalic vein. The catheter is carefully threaded through the vein until its tip reaches a large central vein near the heart, like the superior vena cava. Because the tip terminates centrally, the PICC line is classified as a central venous catheter, despite being inserted peripherally. This central placement allows for rapid dilution of administered substances by the high volume of blood flow near the heart.
Clinical Applications: Why Choose a PICC Line?
The placement of a PICC line in a large central vein makes it suitable for treatments that cannot be safely delivered through a small peripheral IV. Medications highly irritating to the inner lining of smaller veins, such as certain chemotherapy drugs or long-term antibiotics, are primary indications for a PICC line. The rapid blood flow in the central vein quickly dilutes these substances, minimizing the risk of vein damage and inflammation (phlebitis).
A PICC line is selected when a patient requires intravenous therapy for an extended period, often ranging from several weeks to many months. Conditions necessitating long-term infusions, such as chronic infections requiring antibiotics or the need for total parenteral nutrition (TPN), make a PICC line a practical choice. Patients with poor or limited peripheral venous access benefit from a PICC line, as it avoids repeated, painful needle sticks. This single, reliable access point can also be used for routine blood sampling.
The Patient Experience: Insertion, Removal, and Duration
The placement of a PICC line is a sterile procedure performed by trained clinicians, such as nurses or physicians, and typically takes 30 to 45 minutes. The insertion site in the upper arm is numbed with a local anesthetic like lidocaine to minimize discomfort. Placement is often guided using ultrasound technology to accurately locate the vein and ensure the correct path of the catheter.
After insertion, an X-ray or other imaging technique confirms that the catheter tip is correctly positioned in the central vein near the heart. Unlike a peripheral IV, which must be replaced every few days, a PICC line remains in place for the full duration of the prescribed therapy, often weeks or months. Once treatment is complete, a healthcare provider can remove the PICC line at the bedside by gently pulling the catheter out, a quick and simple process.
Essential Care and Monitoring
Proper daily care is necessary to maintain a PICC line’s function and reduce the risk of complications, particularly infection. The insertion site must be kept clean and dry, requiring patients to cover the dressing with an impermeable barrier when showering and avoid activities like swimming or soaking in a tub. The sterile dressing is changed by a nurse on a scheduled basis, often weekly, or immediately if it becomes soiled, wet, or loose.
Patients and caregivers must monitor the site for signs of potential problems, including localized redness, swelling, warmth, or discharge. Systemic signs of infection, such as fever or chills, also warrant immediate medical attention. To prevent blockage, the line is routinely flushed with a saline solution, and patients should avoid strenuous activity or heavy lifting with the arm holding the PICC line.