Departments of Anaesthesia, Haematology,
Medicine and Surgery
Procedure information leaflet
Name of procedure:
Percutaneous insertion of a central venous
catheter [ PICC]
It has been recommended for you to have a PICC line inserted. It is a long, thin flexible tube that is inserted into a vein, usually in your elbow or upper arm.
The tube is then threaded up the vein so that the tip lies in one of the large veins just above your heart. It can remain in place for up to six months.
A specially trained doctor or nurse will insert your catheter. Not all patients are suitable for a PICC line so the doctor or nurse who will insert the tube will assess your veins for suitability.
A PICC line is ideal for people who;
Have small veins which are difficult to find or access.
Need treatment such as chemotherapy or long term antibiotics.
Require liquid food to be given into a vein if their digestive system is not able to cope with oral food for any reason.
Are having regular blood samples taken for testing.
This leaflet explains some of the benefits, risks and alternatives to the operation. We want you to have an informed choice so you can make the right decision. Please ask your medical team about anything you do not fully understand or want to be explained in more detail.
We recommend that you read this leaflet carefully. You and your doctor (or other appropriate health professional) will also need to record that you agree to have the procedure by signing a consent form, which your health professional will give you.
Benefits of the procedure
The aim of the procedure is to insert a central venous catheter to safely administer drugs, liquid food or take blood samples over a period of time.
Serious or frequent risks
Everything we do in life has risks. A central venous line is considered to be safe, but occasionally there can be side effects and complications. These include:
There is a risk of infection in the skin, vein or tube itself. This may require treatment with antibiotics or occasionally the tube may have to be removed if the infection is serious. o Blockage of catheter;
Sometimes the catheter can become blocked. This is usually treated by flushing the catheter with a sterile salt solution. Alternatively the tube may need to be removed if the blockage cannot be relieved.
o A blood clot;
This can form at the tip of the catheter and may result in blockage of the catheter or vein (or both).
o Nerve damage;
The local anaesthetic used during the procedure can sometimes affect the nerves
supplying the arm on the side the procedure is taking place. These pass close to the vein in which the catheter is to be inserted. This can cause weakness, numbness and tingling of the arm or hand grip – this will usually resolve within six hours. Permanent damage to nerves is very rare.
o Bleeding;
There is a small risk of puncture of an artery or a vein causing bleeding which usually stops without further treatment. Rarely a blood transfusion may be required. Very rarely an operation may be necessary to stop the bleeding.
Patients who are more at risk due to low platelets or poor blood clotting may need to be given these blood products into the vein before or after the procedure (or both)
o Entry of air into the catheter;
This is a rare but serious risk and can result in air entering your circulation leading to failure of your heart to beat properly. This is called an air embolus. It is avoided by the use of special clamps which keep the catheter closed when not in use.
o Breakage or damage to the catheter;
Occasionally the catheter can wear out and may break. If it cannot be repaired then the catheter will need to be removed.
o Incorrect positioning of the catheter tip.
Although care is taken during the insertion of the catheter, sometimes the tip can pass into an incorrect position including passage into an adjacent artery. You will usually have a chest x-ray during or after the procedure to check that the catheter is in the right place. If it is shown not to be in the right place then it will need to be removed.
o Abnormal heart rhythm.
Sometimes the catheter tip can pass into the heart and can cause abnormalities with the rhythm of your heart. This is easily corrected by changing the position of the catheter. o Cardiac Tamponade.
If the tip of the catheter passes into the tissue bag that surrounds the heart this can cause the bag to fill with fluid/blood and compress the heart affecting its ability to work properly. This is a very rare complication and may be treated.
You will be cared for by a skilled team of doctors, nurses and other healthcare workers who are involved in this type of procedure every day. If problems arise, we will be able to assess them and deal with them appropriately. It is important that you take care of your catheter because of the risks involved.
Other procedures that are available
There are other ways of administering drugs, liquid food and taking repeat blood samples, for example, by injection into an arm vein or a tunnelled central line[Hickman line]. If you are receiving a long
course of treatment the central venous catheter will have been recommended to avoid the need for numerous injections. In addition some medication can only be given by a central venous catheter.
Preparation before your procedure
Tell your doctor or nurse if you have previously had an allergic reaction to any local anaesthetics. You are recommended to keep to a light diet for six hours prior to your procedure.
Your normal medicines
Continue to take your normal medicines up to and including the day of your procedure. If we do not want you to take your normal medication, your medical team will explain what you should do.
If you are taking anticoagulant drugs (for example, warfarin or heparin ), please let your consultant know as this may need to be stopped a few days before your procedure.
Your anaesthetic
There is usually no need for a general anaesthetic. The catheter will therefore be inserted under local anaesthetic. You should not feel any significant pain when the catheter is put in but you may feel some discomfort.
During your procedure
The skin on your arm will be cleaned with an antiseptic solution. Your doctor will inject a local anaesthetic into the area where the catheter will be put in.
Usually a needle will be inserted into a vein in your upper arm or elbow. This is called the ‘insertion site’. A guide wire will then be passed through the needle and along the vein. The needle will then be removed and central venous catheter will be threaded over the guide wire and into the vein. During the procedure you may be asked to bend your neck to try and put your ear to your shoulder of the side the insertion is taking place, this is to help the line to go in the correct direction.
The position of the insertion site will vary from person to person. If you wish, you can ask the doctor who is going to put the central line in where the insertion site is likely to be on your arm.
Once the PICC line is in place a dressing will be applied to cover the insertion site.
After your procedure
After your PICC line is inserted you will usually have a chest x-ray to confirm that it is in the correct position.
If you have any pain or discomfort, you may be given a simple painkiller such as paracetamol.
Looking after your catheter
While you are in hospital, the nursing staff will look after your PICC line. This involves;
Cleaning the exit and applying a new dressing; and
Flushing the line to prevent blocking when it is not in use.
The line will be cared for by the district nurse or clinic nurse when you leave hospital.
Personal hygiene
You should not wet your dressing and line following your procedure. Waterproof coverings are available to protect the line whilst showering.
Removal of central line
When you no longer need the central line it will be taken out. A nurse or doctor will do this for you. You will not need to have a general anaesthetic.
You will be asked to lie flat on a bed. Your arm will be cleaned with antiseptic, and the line will be gently but firmly pulled until it loosens and comes free. This does not usually take more than a few minutes and can be uncomfortable.
A dressing will be put over the exit site and you will be asked to remain lying down until it is certain that there is no bleeding.
Contact details
If you have any specific concerns that you feel have not been answered and need explaining, please contact the following.
Beech Ward Nursing Staff (phone 01905 763333 - bleep 414)
Surgical Discharge Co-ordinator (phone 01905 763333 - extension 33069) Anaesthetic and Theatre Nursing Staff (phone 01905 763333 - bleep 168)
Haematology specialist nurse
Oncology
Other information
The following internet websites contain information that you may find useful.
www.worcestershirehealth.nhs.uk/Acute_Trust
Information about Worcestershire Acute Hospitals NHS Trust
www.patient.co.uk
Information fact sheets on health and disease.
www.nhsdirect.nhs.uk
On-line Health Encyclopaedia and Best Treatments Website.
Patient Services Department
It is important that you speak to the department you have been referred to (see the contacts section) if you have any questions (for example, about medication) before your investigation or procedure. If you have any concerns about your treatment, you can contact the Patient Services Department on 0300 123 1733. The Patient Services staff will be happy to discuss your concerns and give any help or advice.
If you have a complaint and you want it to be investigated, you should write direct to the Chief
Executive at Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD or contact the Patient Services Department for advice.
Please contact Patient Services on 0300 123 1733 if you would like this leaflet in another language or format (such as Braille or easy read).
