- Reference Number: HEY-1349-2022
- Departments: Nutrition Support
- Last Updated: 30 October 2022
Introduction
This advice sheet has been produced to provide you with information about PICC insertion. It is not meant to replace the discussion between you and your Clinical Nurse Specialist (CNS). If after reading it, you require further explanation, please discuss this with the CNS from the Nutrition Team.
What is a PICC?
A PICC is a long thin flexible catheter that is inserted into a one of the veins in your upper arm. The Tip of the PICC sits in the large vein above your heart, the other end of the PICC comes out of your arm, this is secured to your skin with a fixation device and clear adhesive dressing. A PICC can have one (single) or two (double) ends called lumens, the treatment you are having will determine how many lumens you require. Not everyone is suitable for a PICC your CNS will assess and discuss your ongoing requirements with you.
Why do I need a PICC?
A PICC can be used to allow Parenteral nutrition (PN), Intravenous fluids (IVF) and antibiotics to be administered intravenously (administered directly into a vein). In addition, it can be used to take bloods samples, which reduces the need for multiple needle punctures in your arm.
PN & IVF can be given in the short term via peripheral cannulas, having this type of temporary access can prevent the nutrition team providing you with the full nutritional requirements that you require to recover after your surgery.
PN can sometimes be irritant to your veins, which requires this type of access to be removed and replaced, having breaks in your ongoing treatment, which is not ideal.
Having a PICC provides the Nutrition team with the appropriate central access to prescribe and administer your treatment to assist in your recovery. It will be reviewed regarding the length of time it is required to be in place, if required the PICC can stay in place for longer-term treatment, your CNS will discuss this with you if this is required.
Can there be any complications?
Insertion of a PICC carries a small number of complications however, these are extremely rare and are described below, your CNS will go through these with you. In more detail.
Bruising and bleeding around the insertion site: You may feel some slight discomfort or ache in the arm where the PICC was inserted, this can be quite normal. There may be some bruising around the insertion site and some blood maybe seen. There is nothing to worry about. Ensure you continue to move your arm normally. If the symptoms do not ease this after a few hours, speak with your nurse on the ward regarding taking some mild pain relief as prescribed.
Infection: Every precaution to prevent infection is taken when placing the PICC. However, the nurses and doctors using the PICC are trained to use an aseptic technique to access it with the least chance of causing infection and will provide your ongoing weekly care to the site/PICC.
Thrombus or Clot: with any indwelling venous device there is the risk of thrombosis or a blood clot, this can form around the tip of the PICC internally. The ward staff are trained to observe your PICC site, if you notice the site becoming painful or if you develop any swelling to your arm please speak with a member of staff.
Catheter malposition: In some cases, the tip of the PICC can move out of the ideal placement position making it less safe to use. The PICC has external centimetre markings that the nurses observe before using the catheter. Please tell the nurse looking after you, if you pull the line or if it feels different when it is flushed. If malposition occurs, a Chest X-ray is required to confirm PICC tip position. If it is not in the correct position, the PICC cannot be re-inserted and would need to be removed.
The catheter can cause irritation to the arm and vein if there is any regular repetitive motion, this is not normally a problem while an inpatient in hospital but certain sports such as golf or tennis can lead to complications. Patients that are discharged with a PICC can discuss this with their CNS
What happens during the procedure?
The PICC is placed at the bedside and is guided by specialist equipment. PICC insertion is an invasive procedure; your CNS will discuss the procedure itself, the risks, benefits and will ask you to sign a consent form. A pre insertion assessment checklist will be completed with you prior to PICC insertion. The procedure takes around 30-60 min from the initial completion of the documentation, moving furniture and setting up of the bedside equipment.
The CNS will scan your upper arm using an ultrasound probe to find the most suitable vein. Once located your arm will be cleaned with antiseptic solution and you will be covered with a sterile drape. Your CNS will inject some local anaesthetic to numb the insertion site. You should not feel any pain during the procedure; you will feel some pushing down onto the skin whilst the CNS is working. Once numbed, a needle is inserted followed by a guidewire to allow the PICC to be placed more easily. The PICC Tip position is usually confirmed with a special ECG device that looks at the waves produced by your heart. In some cases, it may be necessary to have a chest x-ray, particularly if you have a condition called Atrial Fibrillation (AF or a fast heart rate) or if you have any implantable/ internal device in place. A chest x-ray in this instance would be used to confirm Tip position of the PICC.
Once the catheter is placed a securement device and clear adhesive dressing will be applied over the top to keep it clean, dry and sterile, this will be changed 24 hours after placement by the ward staff and then changed every 7 days. A thin loose elasticated tube dressing will also be given to you to keep the ends of the catheter secure.
Line removal
Your line can stay in place for as long as it is needed for your ongoing treatment, this will be assessed regularly and can be used in the community if needed; your CNS will discuss this with you. Usually it will be removed before your discharge, a ward nurse will remove the dressing and gently pull the PICC, slight pressure will be applied for a few minutes to prevent bleeding, a small dressing is then applied to the site that will need to stay in place for 24 hours. Removal is not painful and the site will heal naturally.
If it is not removed prior to discharge a district nurse will be arranged to provide your 7-day/weekly care to flush the PICC and change the dressing.
Should you require further advice on the issues contained in this advice sheet, please do not hesitate to contact the CNS on 07827937025
This leaflet was produced by the Nutrition Team, Hull University Teaching Hospitals NHS Trust and will be reviewed in October 2025
Ref: HEY1349/2022
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
