Background Information:

What are the other Names for the Procedure?

• Peripherally Inserted Central Catheter
• Peripherally Inserted Central Venous Catheter

What is PICC Line Insertion radiology procedure? (General Explanation)

• A PICC line is a long flexible catheter that is used for intravenous (IV) medications or blood draws for an intermediate time frame (1-2 weeks)
• A PICC line is used in place of an IV line, because it is less likely to clot and protects smaller veins from certain medications that may cause damage (chemotherapy and certain antibiotics)

What part of the Body does the Procedure involve?

A PICC line is inserted in one of the large veins (typically in the upper arm) and the tip sits in the large vein near your heart.

Why is the PICC Line Insertion radiology procedure Performed?

A PICC line is inserted for prolonged venous access for:

• Chemotherapy
• Long-term IV antibiotics
• Administration of blood products
• Inaccessible peripheral veins

What are the Alternative Choices for the Procedure?

In some cases, a midline (a slightly shorter line) can be used as an alternative to a PICC Line Insertion radiology procedure.

What is the Equipment used? (Description of Equipment)

The following equipment may be used for the PICC Line Insertion radiology procedure:

• A tourniquet is used to reduce blood flow to the vein for a short time
• Commonly, an ultrasound machine is used to identify a large vein in the arm
• A local anesthetic is injected using a small needle
• A needle is then used to access the vein
• A flexible, sterile guide wire is passed through the needle
• The long flexible tubing, the PICC line, is then passed over the wire into the desired location. The PICC line, commonly, has multiple lumens, so different medications can be given at the same time

What are the Recent Advances in the Procedure?

Recent advances in PICC lines include specialized coatings, to prevent infection or clot formation within the line.

What is the Cost of performing the PICC Line Insertion radiology procedure?

The cost of a PICC Line Insertion procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the need of a PICC Line Insertion procedure and what needs to be done.
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician.
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently.

What are some Helpful Resources?

Hudman L, Bodenham A. Practical aspects of long-term venous access. Contin Educ Anaesth Crit Care Pain. 2013;13(1):6-11. https://academic.oup.com/bjaed/article/13/1/6/281092/Practical-aspects-of-long-term-venous-access. Accessed Feb 6, 2017. doi: 10.1093/bjaceaccp/mks039.

Moureau N, Lamperti M, Kelly LJ, et al. Evidence-based consensus on the insertion of central venous access devices: Definition of minimal requirements for training. Br J Anaesth. 2013;110(3):347-356. https://academic.oup.com/bja/article/110/3/347/249521/Evidence-based-consensus-on-the-insertion-of. Accessed Feb 6, 2017. doi: 10.1093/bja/aes499.

Cheung E, Baerlocher MO, Asch M, Myers A. Venous access. Can Fam Physician. 2009;55(5):494-496. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682308/. Accessed Feb 6, 2017.

Prior to PICC Line Insertion radiology procedure:

How does the PICC Line Insertion radiology procedure work?

The PICC Line Insertion radiology procedure works in the following manner:

• Ultrasound guidance uses sound waves to generate images in a similar manner to a ship’s sonar
• The ultrasound generates soundwaves, which is produced by the transducer
• The soundwaves travel from the transducer through the body, and bounce back after they hit the body structure. Using the time it takes for sound waves to return, the computer generates images that can be studied by the healthcare professional
• Using these images, the healthcare professional can identify the large vein and pass the long thin plastic tubing (the PICC line) into the large vein near the heart

The small veins can be damaged by certain medications and the PICC line protects these veins, while still allowing the medication to reach the bloodstream.

How is the PICC Line Insertion radiology procedure Performed?

A PICC line is inserted in the following manner:

• The patient is asked to lie on their back
• A tourniquet is used to temporarily stop the flow of blood through the vein
• The healthcare provider may use an ultrasound to locate the vein for the procedure
• The area is cleaned and surrounded by sterile drapes to prevent infection
• A small needle with a local numbing medicine is injected near the site
• Once the area is numb, a larger needle is used to the access the vein
• Once the vein is accessed, a guide wire is threaded through and the needle removed
• The PICC line is then be guided over the wire into its final position
• Following the insertion of the PICC line, a chest X-ray is taken to ensure proper positioning of the line
• After confirmation, the PICC line will be sutured in place, with help of sterile sutures

Where is the Procedure Performed?

A PICC Line Insertion radiology procedure is usually inserted as an inpatient procedure at a hospital.

Who Performs the Procedure?

Depending on the institution, typically physicians or specially-trained nurses insert PICC lines.

How long will the Procedure take?

The duration of the procedure may vary, but in general, the PICC Line Insertion radiology procedure should take less than an hour.

Who interprets the Result?

A radiologist will confirm the proper positioning of the PICC line on a chest X-ray, which is informed to the healthcare provider who inserted the line.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a PICC Line Insertion radiology procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Women should inform their physicians if they are breastfeeding, pregnant, or if there is a chance that they might be pregnant
• Patients should inform their physician, if they are allergic to any medication
• The patient may be asked to avoid eating or drinking several hours before the test

What is the Consent Process before the Procedure?

A physician will request your consent for the PICC Line Insertion procedure using an Informed Consent Form.

Consent for the procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the procedure:

• A PICC line can be cared for at home
• The risk of infection is much lower than other central access procedures, such as central lines
• It allows fluids, blood transfusions, or medications (chemotherapy or antibiotics) that would otherwise require an IV line
• Multiple lumens allow drugs that cannot mix to be given together

Following are the risks of the procedure:

• With repeated or prolonged use, the veins may develop scarring
• There is a small chance of damaging structures such as the arteries or nerves
• If the catheter is inserted too deep, there is a potential to cause an irregular heartbeat
• The line may develop a clot, which will need to be cleared
• In rare cases, a piece of the catheter may break-off and travel into the bloodstream
• The line may serve as a site of infection
• Rarely, on insertion, the needle can pass into the chest cavity and cause a lung collapse
• Extremely rarely, air can enter the venous system and cause an air embolism. However, the risk of an air embolism has been minimized with newer techniques

What are the Limitations of the PICC Line Insertion radiology procedure?

A PICC Line Insertion radiology procedure is not a long-term access procedure; it is generally used for 1-3 weeks. For longer-term access, additional procedures, such as a venous port placement, may be employed.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is PICC Line Insertion procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During a PICC Line Insertion procedure:

What is expected during the PICC Line Insertion radiology procedure?

The following may be experienced during a PICC Line Insertion radiology procedure:

• A slight poke and burning sensation may be felt during injection of the local numbing agent
• Once the numbing medicine has taken effect, a sensation of pressure will be continued to felt, though no pain is experienced
• There may be some discomfort associated with the insertion of the guide wire

What kind of Anesthesia is given, during the Procedure?

During a PICC Line insertion radiology procedure, a local numbing medicine is administered, prior to the insertion of the larger needle or sutures.

What are the possible Risks and Complications during the PICC Line Insertion radiology procedure?

Possible risks and complications during a PICC Line Insertion radiology procedure may include:

• Rarely, the catheter may become displaced and mal-positioned
• Very rarely, a small fragment of the catheter may break-off and travel into the bloodstream
• The line may serve as a site for infection requiring it to be removed
• Rarely, the needle may be passed into the chest cavity, causing a lung collapse
• Extremely rarely, there is a risk of introducing air into the bloodstream that can be potentially fatal (although, newer techniques have drastically reduced this risk)

What Post-Operative Care is needed at the Healthcare Facility after the PICC Line Insertion radiology procedure?

Following the insertion of the PICC line, a chest X-ray is taken to ensure proper positioning of the catheter. The site of insertion is cleaned and covered with a sterile dressing prior to discharge.

After the PICC Line Insertion radiology procedure:

What is to be expected after the PICC Line Insertion radiology procedure?

Some mild bleeding (spotting on a cloth) or oozing near the insertion site is to be expected on the first day. Individuals, may also notice some bruising and soreness in the area.

When do you need to call your Physician?

Do contact the physician, if any of the following symptoms are observed:

• Fever
• Severe pain
• Warmth, redness, or swelling near the insertion site
• A large amount of (fresh) red blood near the insertion site
• Any tearing or break in the PICC line
• Severe swelling or leakage of fluid around the insertion site

What Post-Operative Care is needed at Home after the PICC Line Insertion radiology procedure?

Post-operative home care is critical to prevent infection in individuals with a PICC line.

• Cover the insertion site with clean, clear plastic wrap prior to showering
• Avoid bathtubs, hot tubs, and swimming pools
• Try to minimize movement and lifting using the arm with the PICC line
• Avoid weight-bearing activities with the arm having the PICC line

How long does it normally take to fully recover, from the Procedure?

• The arm may be sore for 1-3 days following the procedure
• The healthcare provider may restrict how much weight can be carried in the arm, for about 1-2 weeks

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The PICC Line Insertion radiology procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the PICC Line Insertion radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the PICC Line Insertion procedure is performed.