PICC & Midline Placement

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What is a PICC line?
The PICC is a special type of IV catheter that is longer in length (16-24 inches). It is inserted in a large vein in your arm near the bend of the elbow. The catheter is advanced to a blood vessel in your chest so that the tip will end right above your heart. It requires a signed permit before placement.

A PICC is inserted in persons that are requiring IV medications for long periods of time and can last up to 1 year. It may also be used for IV medications such as chemotherapy, IV nutrition and some antibiotics, that are irritating to the smaller veins.
Where is insertion procedure performed?
The procedure may be done, by a specially trained nurse, in your hospital room. Another hospital room may be used if you are not an inpatient. If you are to have the procedure done by the hospital’s radiologist it will be done in the Radiology department.
What happens during the procedure?
The procedure is similar to IV placement, however, stricter sterile technique is used. You may see the nurse or Dr. wearing a facemask, gown and gloves. The arm to be used will be positioned by the provider. It will be cleaned with an antiseptic solution; next a drape with an opening will be placed over your arm. A small needle injection of numbing medication will be given directly under the top layer of skin at the planned insertion site. This will decrease the discomfort during insertion.
Next the vein will be accessed with a special needle and the catheter will be inserted. An ultrasound machine may be used to help view the vein for access. Once the catheter is in the vein, you may be asked to turn your head or move your arm/wrist. This sometimes aids the catheter to move smoothly through the vein. The needle has been removed and an x-ray is done to confirm correct placement. Once the placement is confirmed the catheter will be secured using special tapes, securing devices or sutures. A dressing will be placed over the insertion site.
What happens after the procedure?
In the hospital the staff will change the dressing the following day and then one time weekly thereafter. If the dressing becomes loose or soiled it will be changed more frequently. The nursing staff will also flush your catheter as ordered and assess daily for any signs related to problems with your catheter.
What is a midline?
A midline is a long IV catheter (apox. 8 inches). The midline is placed in a large vein near the bend of the elbow, and then advanced until the tip is near the axilla (arm pit). A trained nurse using sterile technique places it. The arm is cleaned with an antiseptic and draped with a sterile cover. A numbing medication is injected, under the skin at the chosen site to decrease pain with insertion. The catheter is then placed to the vein using a special needle for access. It is used when a patient is requiring IV medication longer than a 3-5 day period, or when there are difficulties placing a regular IV. It can last for up to 30 days. After the procedure care of the line is the same as care for a PICC while hospitalized.

Possible complications:
Cellulitus, infection, blood clot formation, and phlebitis affecting the arm in which the PICC is placed. Other risks involve breakage, malposition of catheter, leaking and occlusion of the catheter.
AT HOME CARE INSTRUCTIONS: PICC & MIDLINE:
Use your arm, as you are comfortable. Avoid lifting more than 10 pounds with that arm.
1. You may shower with the catheter in place. Wrap the area with plastic to keep the site dry. If you must use the bathtub, avoid soaking the arm and use plastic wrap as above. Avoid swimming and any activity that may soak arm as this could lead to infection.
2. It is common to have some vein irritation the first 48 hrs after catheter placement. To avoid this you may use warm moist packs the first 24-48 hrs.

  • Cover the insertion site with plastic.
  • Use a small towel dampened (ring out well) with warm water.
  • Place the towel directly over site where catheter goes into arm.
  • Leave towel in place for 20 minutes and then remove along with plastic wrap.
  • You may repeat this 3 – 4 times a day.

3. Call your doctor or nurse if you have:

  • Increased bruising, swelling or tenderness
  • Warmth or drainage from the insertion site
  • Increased redness at the site your catheter was placed
  • Fever or chills
  • Any problems or questions regarding your catheter