PICC lines used during cancer treatment

Following a cancer diagnosis, the care team may recommend that some patients get a peripherally inserted central catheter, or PICC line. It’s important to know what this line is used for and how to care for it.

What is a PICC line?

Similar to an intravenous line, but longer, a PICC line is a thin 24-inch tube that’s inserted into a vein. It may be used for multiple reasons, including to deliver cancer treatment. This type of central line extends from an arm vein into a large vein that extends to the heart.

This article will provide an overview of how PICC lines are used in cancer treatment, how to care for them and what cancer patients should know. Topics include:

• What is a PICC line used for?
• PICC line placement
• PICC line vs. central line
• PICC line vs. port
• PICC line care at home
• What to keep in a PICC line emergency kit
• Does a PICC line limit activities?
• PICC line removal
• PICC line troubleshooting
• When to call a health care provider

What is a PICC line used for?

PICC lines can be used to deliver potentially lifesaving:

• Medications
• Fluids
• Blood
• Nutrition

These lines may also be used to draw blood. PICC lines are thicker and more durable than standard IV lines and go farther into the vein, so they're also able to supply larger volumes than standard IVs.

During cancer treatment, a PICC line may serve many purposes, including:

• Reducing the number of times a patient may need to have needles inserted
• Lessen the likelihood of medicines leaking
• Giving multiple treatments simultaneously
• Giving blood transfusions
• Delivering medication, including chemotherapy or antibiotics, fluid or blood at home
• Supplying a continuous infusion of chemotherapy
• Allowing doctors to draw blood through the PICC line so there aren’t any new needle pricks needed during treatment or testing

PICC line placement

A PICC line is a soft tube placed into a vein in the arm via these steps:

• Ultrasound imagery is used to identify any vein abnormalities and to choose the insertion site.
• Local anesthesia is applied to numb the area.
• A small needle is used to access the selected vein.
• A wire is advanced through the needle to a large vein in the chest. The needle is then removed.
• An intravenous catheter (PICC) is advanced over the wire and the wire is removed.
• The end of the catheter (its tail) hangs from the area of the arm where the catheter was inserted. The tail may be split into two lines.
• Once placement is confirmed, the PICC line is secured to the skin and a dressing (bandage) is applied over the PICC line.

The entire nonsurgical process takes about 15 to 20 minutes. Patients receiving PICC lines should anticipate some pain or swelling around the site for two or three days after placement, and should avoid lifting anything with that arm (if it was inserted in an arm) or doing strenuous activity.

PICC line vs. central line

The term "central line" describes a category of thin tubes that the care team may use to gain access to a patient's veins. Multiple types of central lines are used for various reasons, but the PICC line is among the most commonly used for cancer patients.

Like other central lines, PICC lines are often left in place for weeks—sometimes longer, which reduces the poking and prodding the patient would have to endure. Another advantage of PICC lines is that they can be divided into more than one line (or lumen), allowing them to do double or even triple duty.

PICC line vs. port

Both ports and PICC lines make it easier to administer medication, blood, nutrition or fluids into the bloodstream.

Unlike a PICC line, a port is a small drum made of plastic or metal that has a rubber-like seal across its top, and a thin tube or line extends from the drum into a vein. Ports are placed under the skin in the chest or upper arm by a surgeon or radiologist. A needle is inserted through the skin into the rubber seal to access the port.

The port may cause a small hump in the skin where it was inserted, but it doesn’t have a catheter tail like with PICC lines.

There are some other key differences between a port and a PICC line:

• Ports are used for longer durations. PICC lines are left in place for weeks or months. Ports can be left in place for months to years.
• Ports require less maintenance than PICC lines, which require daily cleaning and flushing. Ports need to be flushed monthly to prevent clotting.
• PICC lines can’t get wet, but because of their location under the skin, this isn’t an issue with ports.

PICC line care at home

Taking proper care of a PICC line is essential. A PICC line should be kept dry, because getting it wet increases the risk of infection.

Make sure the dressing is clean and dry, and take these steps to properly care for the PICC line:

• When showering, cover the dressing with a plastic wrap.
• If the dressing becomes wet or tears, change it immediately.
• Don’t use lotions, creams or ointments underneath the dressing.
• Keep pets away from PICC lines.
• Keep the clamp(s) closed when the line isn’t being used and when the cap is off.
• The end caps should be protected with a disinfectant cap, which contains 70 percent alcohol and helps to reduce infection. These disinfectant caps are provided by the treating physician.
• Only change the dressing in a sterile environment, making sure to use soap and water during hand-washing, or sanitize them with alcohol-based sanitizer.
• Schedule regular checkups to make sure the PICC line is working properly.

Flushing a PICC line

To care for a PICC line between uses, flush it to rinse out the catheter after each use. Flushing helps keep it clean and may prevent blood clots from blocking the catheter. The line can be flushed with heparin (an anti-clotting drug) to prevent clotting or saline to keep it clean.

Supplies needed to flush a PICC line include:

• Clean paper towels
• Saline syringes or heparin syringes (Check the labels on syringes to confirm that the strength and dose are correct and that they haven’t expired. Some syringes are pre-filled, while others need to be filled.)
• Alcohol or chlorhexidine wipes
• Sterile gloves
• A sharps container (to dispose of used syringes and needles)

To flush a PICC line:

• Wash hands thoroughly and dry them with a clean paper towel.
• Place materials on a new paper towel on a clean surface.
• Put on a pair of sterile gloves and remove the cap on the syringe.
• Unclip the clamp on the end of the catheter, and wipe it with an alcohol swab.
• Screw the saline or heparin syringe to the catheter, and inject the liquid slowly into the catheter by gently pushing the plunger.
• When finished, unscrew the syringe and put it in a sharps container.
• Make sure to clean the end of the catheter again with a new wipe and put the clamp back on.
• Remove gloves and wash hands.

What to keep in a PICC line emergency kit

Patients with PICC lines should have certain items on hand at all times, including:

• Paper towels
• Alcohol pads
• Soap or hand sanitizer
• Dressing or bandages
• Sharps container

Does a PICC line limit activities?

PICC lines allow individuals to receive treatment at home. It’s important to make sure the area is dry and remains covered when bathing.

Exercise, heavy lifting and other strenuous activities should be restricted in the first two weeks after the line is placed. Patients should follow their doctor’s instructions regarding which activities can and can’t be performed with a PICC line.

PICC line removal

PICC lines are typically removed after two to 12 weeks. These lines are removed by doctors, and the site is covered with a bandage. The skin is numbed with local anesthesia. Removal takes less than an hour and is completed as an outpatient procedure.

PICC line troubleshooting

Problems are rarely experienced with PICC lines. Red flags to look for include:

• Infection (redness, swelling, oozing or soreness could be signs of infection)
• A blood clot in the vein (arm swelling or pain)
• A blood clot blocking the PICC line
• Splitting of the PICC line (very rare)

When to call a health care provider

Patients should check the PICC line area daily and call the doctor immediately if there are any signs of infection, such as:

• Fever
• Redness
• Swelling
• Pain
• Tenderness near the line
• Shortness of breath

Infections must be treated with antibiotics immediately. If the infection isn’t treated quickly, the line may have to be removed and replaced with a new one while the infection heals.

Other times to call the care team include when:

• The line comes out.
• The line appears to be blocked.
• The line can't be flushed.
• The catheter is leaking.
• The catheter appears cut or cracked.
• Flushing becomes difficult.