What Is a PICC Line?

A peripherally inserted central catheter, also known as a PICC line, is a long, flexible tube (catheter) that is inserted into a vein in your upper arm. After insertion, the catheter is threaded to a central vein near the heart. The PICC line can be used to deliver fluids and medications, draw blood, or perform blood transfusions.

Having a PICC line reduces the need for repeated needle sticks. It's meant for safer, longer term use than an intravenous (IV) line and your doctor can then remove it when you do not need it anymore.

This article explains when a PICC line is used and the process by which it is inserted and removed. It also outlines the possible risks of a PICC line and what you can do to reduce the risk.

What Is a PICC Line Used For?

A PICC line can be used when a person needs IV therapy of any sort for a prolonged period. There are a number of situations in which this is helpful for both healthcare providers and the people they treat.

Antibiotics or Antifungals

Systemic (whole-body) bacterial or fungal infections can sometimes require daily IV drugs for weeks at a time. This is more easily accomplished when a PICC line is placed and used to deliver these medications. Some of the conditions that may require IV antibiotics over a longer term are:

• Serious urinary tract infections
• Wound care in diabetics
• Osteomyelitis, a type of bone infection often seen with sickle cell disease
• Lyme disease, a bacterial infection transmitted by tick bite

Cancer Treatment

Intravenous chemotherapy drugs used to treat cancer can be extremely irritating to tissues. Rather than delivering them to smaller veins in the arm, the doctor can use a PICC line to deliver them to larger veins where they do less harm.

Liquid Nutrition

Liquid nutrition, also known as total parenteral nutrition (TPN), can be given daily through a PICC line for people who are unable to eat or absorb nutrition.

Some conditions that might require TPN include cancers of the digestive tract, ischemic bowel disease, or inflammatory bowel conditions like Crohn’s disease.

Heart Medications

People who require hospitalization for significant cardiac (heart) care are often treated in the intensive care unit. A PICC line is commonly used to give IV medications to treat congestive heart failure, for example.

Multiple IV Medications

One advantage of the PICC line is that it has more than one port through which drugs can be administered. This is necessary for a number of critically ill patients, including those who need multiple drugs to treat infections, require TPN, or receive IV chemotherapy medications.

A 'Hard' Stick

Healthcare providers often encounter people whose veins are too small or fragile to access well with an IV line. This may be true of older patients and people with specific chronic health conditions.

In fact, one study of 135 patients deemed "highly complex" for these reasons found that 59.3% of them were a "hard stick," meaning it was difficult to establish IV access in their veins.

This also is a significant problem among people whose veins are damaged by IV drug use, and for many people living with human immunodeficiency virus (HIV).

Frequent Blood Draws

PICC lines also may be used when blood needs to be drawn repeatedly, making lab tests easier. They also may be used to perform continuous monitoring in some patients, such as those being treated for heart conditions.

PICC Line Placement Procedure

The PICC line is a catheter with a guidewire inside. This stiffens the tube so that it is easier to thread into a vein.

PICC lines are usually placed by a nurse or physician assistant at the bedside of a person in a hospital or care facility. It can also be done on an outpatient basis in advance of chemotherapy treatments.

The procedure takes about an hour and typically involves the following steps:

1. A vein is selected. A non-invasive imaging tool called an ultrasound may be used to select the best site and guide the line placement.
2. The insertion site is injected with a numbing agent (typically 1% lidocaine solution).
3. After the site is cleaned, a small incision is made to access the vein.
4. The line is gently threaded into the vessel and advanced toward (but not into) the heart. You may feel an unusual pressure but generally no pain.
5. Once the line is placed, it is secured to the skin of the arm with an adhesive securement device or with stitches.
6. An X-ray is performed to ensure the line is correctly positioned.

PICC Line Risks

PICC lines carry certain risks, some of which are manageable and others of which may be life-threatening. Possible complications include:

• Malfunction: PICC lines can become clogged by substances delivered through the line. There are medications that can help break up the blockage, but the line will sometimes need to be replaced.
• Infection: A bacterial infection can develop if the ports or insertion sites are not routinely cleaned and cared for. The risk increases the longer the PICC line remains in place.
• Blood clots: A blood clot can develop at the inner end of the line. If the clot breaks free, it can travel through the heart to a lung, causing a potentially life-threatening obstruction known as a pulmonary embolism. 
  
• Cardiac arrhythmia: If the line is placed too close to the heart (or in the heart), it can trigger abnormal heartbeats known as cardiac arrhythmia. If not treated immediately, the line can end up damaging the heart muscle or valves.

Despite the possibility of complications, the use of a PICC line offers advantages that will typically outweigh them. One recent study of 359 people in Norway who had PICC lines placed during their care found that, although some did experience blockage, leaking, or other complications, most of them said they would choose a PICC line again.

Among the reasons participants gave were their relief over not having to endure multiple needle sticks, or that they were able to go home because the PICC line was inserted for ongoing care.

PICC Line Safety

PICC lines require regular maintenance to avoid infection. In addition to routine dressing changes, the ports need to be regularly cleaned and flushed with sterile fluid. It is also important to wash your hands before touching the ports or any part of the PICC line.

Your healthcare provider will let you know which activities you will need to avoid, such as heavy lifting or contact sports.

You will also need to cover the PICC sites with plastic wrap or a waterproof bandage whenever showering. You should never get the PICC site wet, so submerging your arm in a bathtub or pool must be avoided until the line is removed and the wound is healed.

Seek urgent care if you experience any of the following with a PICC line:

• The port won’t flush.
• The PICC line leaks.
• The portion of the line outside the body is suddenly longer.
• You develop sudden arm or chest pain.
• There is increasing pain, warmth, redness, or swelling around the insertion site.
  
• You develop a high fever with chills.
• You notice changes in your heartbeat, such as palpitations.

PICC Line Removal

The removal of a PICC line is quick and typically painless. The stitches holding the line are removed, after which the line is gently pulled from the arm. Most people say that it feels strange to have the line removed, but it is neither uncomfortable nor painful.

Once the PICC line is out, the end of the line is inspected. It should look the same as it did when it was inserted, with no missing pieces that could be left inside the body.

A sterile bandage is placed over the wound and left for two or three days while the wound heals.

Summary

A peripherally inserted central catheter, also known as a PICC line, is a thin tube placed in a vein of the upper arm and threaded toward the heart. It is used to deliver fluids, medications, liquid nutrition, or blood directly to the bloodstream.

A PICC line can be inserted on an inpatient or outpatient basis by a nurse or physician's assistant. The procedure takes about an hour to perform. To avoid pain, a numbing agent is injected near the insertion site. The placement of the line is often directed by an ultrasound.

PICC lines pose certain health risks, including infection, blood clots, and abnormal heartbeat (arrhythmia). The risk of infection is reduced by routinely changing dressings, flushing and cleaning the catheter ports, and washing your hands thoroughly before touching any part of the line.

A Word From Verywell

Though PICC lines can sometimes cause serious complications, the benefits usually outweigh the risks. Even so, it is important to tell your healthcare provider if you take any medications or have any medical condition, such as a heart rhythm disorder, that may place you at exceptional risk.