Insertion of a Peripherally Inserted Central Catheter (PICC Line) Patient Information
Introduction This booklet has been written to provide information to patients about to have a peripherally inserted central catheter (PICC) in order to receive chemotherapy treatment. It is not meant to replace the discussion between you and the nursing team treating you, but helps you tounderstand more what is discussed. What is a PICC? A PICC is a thin flexible tube that is used to give you treatments such as chemotherapy, antibiotics and/or intravenous (IV) fluids. A PICC can also be used for taking blood samples. A PICC can remain in position for up to twelve months and you can go home with it in place. Why am I having a PICC inserted? A PICC is ideal for people who: Have small veins which are difficult to find. Are very anxious about needles. Need treatment over a long period of time, such as chemotherapy and/or long-term antibiotics. Are receiving drugs that may cause damage to the veins. Whereabouts in my body is a PICC inserted? A PICC is inserted into a vein, usually in the bend of your arm. The PICC is then threaded so that the tip lies in one of the large veins in the chest, as shown in the drawing below. 1
How is a PICC inserted? A specially trained nurse or doctor will insert your PICC. Not all patients are suitable for a PICC, so the nurse or doctor who will insert the PICC will assess your veins for their suitability first. The nurse or doctor may apply a local anaesthetic cream to the area where the PICC will be put in up to an hour before insertion (this will be discussed with you during your assessment for a PICC). This should ensure that the procedure is as comfortable as possible, you will need to lie down whilst your PICC is inserted. The procedure should take approximately 40 minutes to an hour. The PICC will be held in place with an anchoring device (a butterfly shaped dressing used to secure PICCs) and covered with a clear, waterproof dressing. You will also be asked if you can bend your arm without discomfort. After your PICC is inserted, you will have a chest X-ray to confirm that it is in the correct position. What are the benefits of having a PICC inserted? A PICC will prevent you from receiving several needles throughout the course of your treatment. This will prevent long-term damage to your veins that may be caused by receiving several injections over a long period of time. Insertion of a PICC allows the treatment the doctor has recommended for you to be given safely. What are the main risks following the insertion of a PICC? As with most procedures there is a small risk of complications which may include: Bleeding When you have a PICC inserted, the exit site may bleed for a few hours afterwards. This will be observed whilst you are in hospital and a pressure dressing may be applied to control this. You will only be allowed home when the nursing staff is happy that any bleeding is under control. 2
Infection It is possible for an infection to develop either inside the PICC or around the site where it has been inserted. You may be given antibiotics, or occasionally if the infection is serious, the PICC may have to be removed. Blood clots It is possible for a blood clot (thrombosis) to form in your vein at the tip of the PICC. If a clot does form, your PICC may have to be removed. You will also be given some medication to dissolve the clot. Incorrect position of the catheter tip The catheter position will be confirmed on X-ray and may need to be removed or the position readjusted if it is in the wrong place. Break or cut in the PICC It is important that you do not get a break or cut in your PICC. Do not use scissors near the PICC and only use a clamp that is supplied. If the PICC does split or become damaged, try to clamp it above the cut and call your hospital. Your PICC may need to be removed if it cannot be repaired whilst still in place. Symptoms to look out for and report Sometimes there are complications. If you suspect something is wrong, or if you have any of the following symptoms, contact the hospital straight away: A temperature above 38 o C, fever, chills or feel generally unwell. This could be the beginning of an infection. Oozing or discoloured fluid coming from around the PICC. Cracks or leaks. Pain, redness or swelling around the site. If your PICC becomes dislodged. Are there any alternatives to having a PICC? A PICC has been recommended as the most appropriate way to deliver your treatment. Alternative types of catheter are available, please ask your chemotherapy nurse if you would like more information about these. If you have any doubts, or want to ask any questions please talk to a member of your nursing or medical team. 3
What are the consequences of having a PICC? Once the PICC has been removed, you may have a very small scar on your arm where it was inserted. There may be scarring to the vein in which your PICC was inserted. This will heal in time and will cause no long-term effects. However, if you need a PICC in the future, it is unlikely that the same arm will be able to be used. What do I need to do after insertion of my PICC? Sometimes you may have some tenderness, swelling or inflammation of the upper arm where your PICC was inserted. This reaction is most common in the first week following insertion. To minimise these reactions, you should do light arm exercises and apply warm compresses for 20 minutes three or four times a day for 2 days. You will be given instructions on how to do this, by the nurse or doctor placing the line. Also, if you have any tenderness or pain in your arm, taking a simple painkiller such as Paracetamol may help (however, please note it is important that you check your temperature before doing this). If the pain persists, telephone your hospital for advice. Who will care for my PICC? 24 hours after your PICC has been inserted, the dressing will need to be changed, This will either be done by a district nurse or the hospital department will arrange an appointment for you to have this done. Whilst you are in hospital, the nursing staff will look after your PICC. This involves: Cleaning the site where the PICC leaves your arm and applying a new dressing (weekly) Flushing the PICC to prevent blocking when it is not in use (we do this as a minimum once a week). Your PICC will need to be cared for as it will be in place for several weeks. It is possible for you to care for the PICC yourself and the nursing staff can teach you how to do this. You will also be given a detailed information booklet describing the procedures you have been shown. However if you find it difficult to do it yourself a relative or friend can be shown how to do this for you. We can also arrange for district nurses or the hospital nurse to care for the catheter if you prefer. 4
Removal of your PICC When you no longer need your PICC, it will be removed by a member of the nursing staff. Removal of your PICC will take approximately 5 minutes and will be pain free. Frequently asked questions: Can I eat and drink before having my PICC inserted? Yes, you can eat and drink normally before having your PICC inserted. Can I have a bath/shower or swim with a PICC in place? As a general rule, we encourage people with PICC to take a shower. This is preferable to submerging your PICC in bath water because of the risk of infection. Waterproof coverings are available to protect the PICC whilst showering. If you would like to know more about this, please speak to a member of staff. Swimming should be avoided whilst your PICC is in place. Can I lead a normal social life? Having a PICC in place should not interfere with your social life. However, your chemotherapy drugs may temporarily restrict certain social activities either immediately after treatment or if your blood counts are low. Your nurse or doctor will give you more specific information. Can I play sports? There is a risk that your PICC could become dislodged because of excessive upper body movement. Vigorous exercises are discouraged whilst your PICC is in place. Non-contact/gentle exercise should be fine, however, if you experience any pain or problems, please check with your chemotherapy nurse. Can I go on holiday? Please talk to your doctor before planning a trip abroad. It is possible to go on holiday abroad with a PICC in place. However, you need to consider the type of treatment you are having, the duration and destination of your holiday, and whether you have someone to help care for your PICC. If you do travel by air, carry all medication in your hand luggage. 5
Will my PICC affect my sex life? Having a PICC in place should not interfere with your sex life. To minimise the risk of damage to your PICC, ensure it is secure before making love. However, sometimes while you are feeling unwell or having cancer treatment you may lose interest in sex. Adequate contraception is essential during cancer treatment to avoid pregnancy because of the risk of damage to the baby. We strongly advise that you use a barrier method of contraception such as condoms for 7 days following any chemotherapy treatment. This is to protect your partner from any chemotherapy drugs which may be present in the semen or the vagina. Please use the space below to write down any questions you may want to ask: We hope this booklet has been helpful and answered some of your questions but if you are unsure or worried at any time throughout your illness, please ask the doctors or nurses who will explain things in more detail. Glossary of medical terms: Anchoring device: a butterfly shaped dressing used to secure PICCs. Anticoagulant: any substance that prevents blood clotting. 6
Blood count: a test that gives information about the cells in a patient s blood. District nurse: a nurse that can visit you in your own home. Flushing: passing liquid through a PICC when it is not being used, via a syringe, to prevent it from becoming blocked. Intravenous: the administration of liquid substances directly into a vein. PICC: a PICC is a thin flexible tube that is used to give you treatments such as chemotherapy, antibiotics and/or Intravenous (IV) fluids. A PICC can also be used for taking blood samples. Local sources of further information You can visit any of the health/cancer information centres listed below: Birmingham Women's NHS Foundation Trust Health Information Centre Birmingham Women's Healthcare NHS FoundationTrust Metchley Park Road Edgbaston Birmingham B15 2TG Telephone: 0121 627 2608 Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: 0121 424 2280 Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: 0121 424 9486 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ 7
Telephone: 0121 507 3792 Fax: 0121 507 3816 University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre University Hospital Birmingham NHS Foundation Trust Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: 0121 697 8417 Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: 0800 783 9050 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: http://www.birminghamcancer.nhs.uk. This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham Hospitals NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: March 2010 Review Date: March 2013 8