A PICC is a long, thin, flexible tube known as a catheter. It is inserted into one of the large veins of the arm near the bend of the elbow. It is then slid into the vein until the tip sits in a large vein just above the heart.

The space in the middle of the tube is called the lumen. Sometimes the tube has two or three lumens (known as double or triple lumen). This allows different treatments to be given at the same time. At the end of the tube outside the body, each lumen has a special cap, to which a drip line or syringe can be attached. Sometimes there is a clamp to keep the tube closed when it is not in use.

The PICC line can be used to give you treatments such as chemotherapy, antibiotics and intravenous fluids and feeding. It can also be used to take samples of your blood for testing. You can go home with the PICC in and it can be left in for weeks or months. This makes it possible for you to have your treatment without having to have needles frequently inserted into your veins. This may be particularly helpful if your veins are hard to find or have been hardened by previous chemotherapy treatment.

Your PICC will be put in by a specially-trained nurse or doctor, in an outpatient department or on the ward. It will be put in using a local anaesthetic, so that you do not feel any pain.

First, the skin in the area where the PICC will be inserted is numbed, using a special anaesthetic cream. When the skin is completely numb, a needle will be inserted and then removed. While the needle is being removed, the PICC is threaded through it into the large vein which leads to your heart. This should not take long and is usually painless. The PICC will be held securely in place by a transparent dressing. You will then have a chest x-ray to check that the end of the tube is in the correct position.

If your veins are small, it may be difficult to put the PICC in. Sometimes it can be difficult to thread the PICC up the vein towards the heart. If this happens, it is possible to try again using a different vein.

Sometimes the PICC seems to go in easily but the x-ray shows it is not in the right place. If this happens it will be taken out and replaced.

When the line is not being used there is a slight risk that it may become blocked. To stop this happening a small amount of fluid is flushed into the line using a syringe. This is done regularly, usually once a week. The dressing will also need to be changed each week to reduce the risk of infection.

As it is difficult to do this yourself with one hand, the nurses at the hospital may do it for you or arrange for a district nurse to visit you at home. A partner, relative or friend can also be taught to do this if they feel happy to.

Infection

It is possible for an infection to develop inside or around the place where the line goes into the vein. If this area becomes red, swollen or oozes, or if you develop a temperature, you should tell your hospital doctor or nurse. You will be given antibiotics or, occasionally, the line may have to be removed.

Clots

It is possible for a blood clot (thrombosis) to form in your vein at the tip of the PICC. You may be given a tablet of warfarin (an anticoagulant) to take each day to help prevent this. If you do develop a blood clot, you will be given medicines to dissolve the clot and your line may have to be removed. Signs of a blood clot around the PICC include swelling, redness or tenderness in the arm, chest area or up into the neck (on the same side as the PICC).

Air in the line

Air must not be allowed to get into your PICC line. The clamps should always be closed when the line is not in use. The line must not be left unclamped when the caps are not in place.

Break or cut in the PICC

It is important that the PICC line is not cut or split. Do not use scissors near the PICC. If it does get damaged you should contact your hospital immediately as it may need to be removed if it cannot be repaired while still in place.

When you no longer need a PICC it will be taken out. A nurse will usually do this for you in an outpatient department. It will be gently pulled out. This is a painless procedure that takes only a few minutes.

This section has been compiled using information from a number of reliable sources including:

• Oxford Textbook of Oncology (2nd edition). Souhami et al. Oxford University Press, 2002.
• Cancer and Its Management (4th edition). Souhami and Tobias. Oxford Blackwell Scientific Publications, 2003.
• The Chemotherapy Source Book (3rd edition). Perry, Lippincott Williams and Wilkins, 2001.

For further references, please see the general bibliography.