PICC LINE AND PORT PLACEMENT
Vascular Radiology & Vein Treatment
A Peripherally Inserted Central Catheter (PICC), is a long, thin, soft plastic tube that functions as an intravenous (IV) line. A PICC line allows nurses and doctors to administer medications and fluids on a frequent basis. A PICC can remain in place for as long as you need IV therapy.
Using ultrasound technology to visualize an appropriate vein in the upper arm, the PICC catheter is inserted by a specially trained interventional and vascular radiologist. After insertion, a chest x-ray is obtained to confirm ideal placement. The procedure is done in our Vein Clinic at the Blue Ridge facility on an outpatient basis.
A PICC line may be requested for a variety of treatment needs which include some of the following:
- prolonged IV antibiotic treatment
- For other medications including vitamins, treatment of neurologic and other
- TPN Nutrition
- blood transfusions
- home or sub-acute discharge from hospital with need for extended treatment extended treatment
A port is a device that is implanted under the skin and provides access to your veins. The port can stay in place permanently, if necessary. When not in use, the only care a port requires is flushing once a month with a special saline solution to keep blood clots from forming in the line.
Ports are implanted by an interventional radiologist. Two incisions are made, a small one near the collarbone and a larger incision usually a few inches below the first incision where a reservoir pocket is formed. Both of these are sewn with dissolvable sutures and covered with a special sterile adhesive that will fall off or can be removed once it heals.
When the port is accessed, a special needle is placed through the skin into the reservoir. A catheter under the skin connects the reservoir to a large vein, usually in the chest. This allows you to receive medication, blood, or to have lab samples taken. In addition, contrast injections as part of various imaging tests such as CT and MRI can be performed as our physicians only implant power ports.
What does PICC stand for?
PICC is the acronym for peripherally inserted central catheter.
Where will the PICC line be placed?
A PICC line is usually placed in the front bend of the elbow also known as the antecubital fossa. There will be 1 or 2 connections that your physician can administer IV or medication fluids.
How long will the PICC line procedure take?
It should only take 30 minutes including prep time.
How long will the PICC line stay in?
It can be as little as a few days to extended lengths up to several months. This is determined by your treating physician.
How do I care for the PICC line once it is in?
A secure, clean and intact dressing is essential to prevent catheter migration and infection. The dressing should be changed every seven days or more if needed. It is often helpful if a friend or family member is taught how to change the dressing, even if home care is used, to insure the dressing remains dry as a moist dressing is the perfect breeding ground for infection.
When dressing changes are being done, insure that the anchoring devise, Biopatch and injection caps are also changed at that time. Dressings should be inspected daily. If it is wet, soiled or leaking, it must be changed. Dressings should be removed by loosening the adhesive, using alcohol if necessary. Scissors should never be used due to the possibility of cutting the catheter in error.
Hands should be washed properly with an antiseptic solution prior to handling the catheter or supplies. Scrub hands thoroughly. Be sure to include the palms back of hands, fingers and spaces between them and fingernails. Rinse them with running water with hands pointing down so the water flows downward. Dry them with a dry paper towel.
Clean the catheter caps with alcohol swab pads prior and post each use.
What is a port?
A port is a device that allows an easy and reliable way to give medicine into the veins and take blood samples from the veins. It can also be used for certain diagnostic studies such as CT or MRI with contrast our physicians only place “power ports”.
Where is a port placed?
It is implanted under the chest skin. It is about a half inch thick and about the size of a quarter. You can feel its raised center under your skin. A flexible piece of tubing (catheter) is connected to it. This is tunneled under the skin to an area near the neck where it enters a vein.
The center of the port is made of a tough, self-sealing, rubber-like material that can be punctured through the chest skin with a special needle many times. Each time it will reseal instantly.
Why do I need a port?
Since you may need frequent intravenous (IV) medicines or blood draws, your healthcare provider has ordered a port for you. Patients who have ports often say that they are relieved that they do have to be poked over and over to find a good vein. Because the port is implanted under the skin it is not very noticeable. Once it has healed, it needs little care from you. People like the fact that they can go with their normal daily routines (including showering an swimming) without worrying about the port.
What are the risks?
Infection: Once the port is in place and healed, there is little chance of infection. There is a small risk of infection until the port heals.
Another time the port is at risk for infection is when the port is “accessed”. This is when a trained person inserts the proper needle into the middle rubber portion of the port. Only a healthcare provider experienced in port care should do this.
Bleeding: Because a small incision will be made in the chest skin and a puncture in the vein there is a chance of bleeding in the form of bruising or oozing of blood from the incision. Laboratory work will be reviewed before the port is placed to help ensure that your blood clots properly so that there is little concern about bleeding.
How do I prepare for the port procedure?
A staff member from the Interventional Radiology Department will call you to review this information with you. Please tell the team member if you take blood thinners, are allergic to anything, or are pregnant.
Do not eat or drink anything for 6 hours before the port insertion.
In general, you may take your normal morning medicines with a sip of water.
On the day of the procedure, women are asked to wear the type of bra that they normally wear. A nurse will mark where you bra strap lays so that the port can be inserted in an area where the bra strap will not rub.
Because you will only need to take off your clothes from the waist up, you should were comfortable bottom clothing and a top that is easy to take off.
You must have someone with you to drive you home after the procedure.
How is the port inserted?
Before the procedure an intravenous line (IV) will be placed in your arm. The IV will be used to give you an antibiotic, a sedative or medicine to help you relax, and pain medicine.
You will be taken to the radiology suite where a technologist will wash your upper right or left chest and neck with a special soap. To reduce the risk of infection, your chest, neck, and head will be covered with a sterile drape. The drape is made into a tent so that it does not lie on your face. The drape is cut open so that you can see out from under it.Once you are ready for the procedure, the nurse or physician will begin to give you the sedative and pain medicine in your IV. The radiologist will also inject a local numbing medicine under the skin. This burns for a few seconds but then the skin will be numb.The radiologist will insert a small tube into the vein in your neck. Then, a small pocket will be made under your chest skin about 2-3 inches below your collarbone. The port will fit into the pocket. After that, the tubing that is connected to the port is tunneled under the chest skin so that it enters the neck vein. All of this is done under the guidance of fluoroscopy (real time x-ray seen on a TV screen) and ultrasound.Once everything is in place the neck site and the port pocket will be closed with absorbable sutures under the skin and sterile surgical glue.After the procedure you will recover for about 2 hours. Your heart rate and breathing will be watched. The port site will be checked often to make sure that you don’t have too much bleeding.Once you have recovered, your driver can take you home to rest.
How do I care for the port?
Keep the port site completely dry for 48 hours. Do not submerge in water for 2 weeks, no swimming, bath or hot tubs, etc. After the initial 48 hours you may take showers. Try to keep your back to the pray and towel off gently. After 2 weeks, if the incision is well healed, you may resume to normal water related activities as long as your doctor has not left a needle in place for home based therapy. You can use saran wrap and tape to cover the site for showering. This will prevent infection until the port is healed.
Keep a dressing over the port site for the first 3 days. After that, the dressing should be removed. Do not do anything special to the site except keep it open to air and dry. Do not put antibiotic ointment or lotions or creams over the incisions.
You should have little pain. At home, over-the-counter medicines that you take for aches and pains can be used if you have discomfort at the port site.
Women should wear a bra during the day. Check the port site for signs of infection:
Extreme warmth at the site
Once the port has healed and is not being used regularly it will need to be flushed every month so that it does not clot off. This should be arranged with the clinic that used your port for treatments or blood draws.