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Peripherally inserted central catheter: Care at home

What is a peripherally inserted central catheter?

A peripherally inserted central catheter is often called a "PICC line." It is a long, very thin, flexible tube that is inserted into one of the large veins above the elbow. This tube is threaded into a large vein that is located near the heart.

Why does my child need a PICC?

The PICC line will be used to give your child IV medicines or fluids. Sometimes it is also used for blood samples. Because the tube is small and flexible, the line usually lasts several weeks to months, which means fewer needle pokes and less pain.

Your child's catheter:

Type:

Size and manufacturer:

May be used for X-ray contrast studies:

yes or no

___ Blood samples can be taken from the catheter.

___ Blood samples cannot be taken from the catheter.

How should I care for my child?

Caring for a child with a PICC line may be a little scary at first. The nurses will take care of the line and give the medicines while your child is in the hospital. As your child improves and is able to be at home, you may be taught how to give medicine through the PICC line.

Home care nurses will teach you and help you become comfortable with the procedures before you do them yourself.

These are the special things that need to be done:

  • preventing infection
  • flushing the PICC line
  • giving the medicine
  • solving problems
  • knowing when and who to call for help

Preventing infection

PICC catheters are helpful for taking care of your child; however, they can increase the risk of infections when bacteria grow in the catheter and travel to the bloodstream. This is called a Central Line Associated Blood Stream Infection or CLABSI. A CLABSI can be serious and life threatening.

It is very important to prevent infection, which might require removal of the PICC line. The nurse will show you how to keep your supplies sterile, so no germs will enter the catheter and cause an infection.

Members of your health care team take steps to prevent infection such as washing their hands and using gloves. Parents and patients also have a role to play in preventing CLABSIs.

Cleanliness is a must! Each time you do a procedure with the PICC line, follow these steps:

  1. Prepare a clean work area by cleaning a solid surface with a disinfectant (such as Lysol® or another brand).
  2. Wash your hands well, using one of the following methods:
    • Use an alcohol-based hand sanitizer (Purell® or another brand) according to directions
    • If alcohol-based sanitizer is not available, wash your hands with antibacterial soap for at least 15 seconds, rubbing all surfaces briskly, including between your fingers and under your fingernails. Use a paper towel or clean hand towel to dry your hands, and then use the towel to turn off the faucet.
  3. Before each time you flush or put any medicine into the IV tubing, put on non-sterile gloves and scrub the injection cap for 30 seconds with a fresh chlorhexidine wipe, using friction. Let it dry. Do not fan or blow on it.
  4. Perform hand washing before caring for your child's PICC line. This includes: administering medication, cap change, dressing change, and any time handling the PICC line.

How do I order supplies?

Your supplies will be ordered from a medical equipment supply company or home care pharmacy. The first order will be delivered to the hospital or your home. Check with your nurse to be sure you have everything you need. You will receive the number to call when you need to order supplies in the future.

Flushing the PICC line

The PICC line must be flushed with normal saline to help prevent blood from clotting and blocking it. If the line becomes blocked, it may have to be removed.

When IV fluids are running through your child's PICC line, it is being flushed continuously. When the PICC is not being used, it must be flushed at these times:

  • before and after giving medicines or fluids.
  • after drawing blood.
  • at least every 12 hours.

For example, if your child needs medicine once every 24 hours, the line should be flushed before and after the medicine is given, and 12 hours later.

Heparin is a medicine that prevents clotting and helps keep the PICC line open. Before giving medicine or fluid, flush the line with normal saline. After the dose, flush it twice: once with normal saline and once with heparin. Follow the instructions under "Giving medicine and flushing the PICC line," below.

You must use 10-ml or larger syringes. A smaller syringe may push too much pressure into the catheter and cause it to burst.

Filled syringes have an air bubble in them. Before using, hold the syringe upright and pull slightly back on plunger and squirt the air bubble out.

If at any time you meet resistance when flushing the PICC line or giving the medicine, do not force it. Call your doctor or home care nurse for help.

Giving medicine and flushing the PICC line

Note: Every time you flush the PICC line with normal saline or heparin, use the "push-and-pause" method: push a little solution, then pause for 1 to 2 seconds, then push a little more, pause, and so on. This method cleans the inside of the catheter. Your home care nurse will show you how to do it.

    1. Prepare the work surface (see above).
    2. Wash your hands well (see above).
    3. Gather supplies:
      • chlorhexidine wipes
      • normal saline syringes (2)
      • heparin syringe
      • IV medicine you will be giving, if any
      • non-sterile gloves
    4. Put supplies in order of use on the work surface.
    5. Check the labels of the normal saline and heparin syringes, and any other medicines or fluids before giving them. Make sure they are the right medicines.
      • A medicine is good until the expiration date. Throw it away sooner if you see sediment in it or if you question its cleanliness. If you do throw a medicine away, be sure to call the home care pharmacy for a replacement dose.
Preparing pre-filled syringes:
ALL pre-filled syringes have an air bubble in them (normal saline, heparin, medicine). Remove the tip cover from the syringe and point the syringe upward, pull back slightly on plunger and squirt air bubble out.
  1. Put on non-sterile gloves.
  2. Scrub the injection cap with a chlorhexidine wipe for 30 seconds and let it dry.
  3. Attach normal saline syringe tip into the injection cap.
  4. Unclamp the catheter.
  5. Flush with normal saline using the push-and-pause method. When syringe is empty, remove it from the injection cap.
  6. If you are not giving medicines at this time, go to step 17.
  7. If you are giving medicines, scrub injection cap with a new chlorhexidine wipe for 30 seconds and let it dry.
  8. Connect the medicine and give as instructed by your home care nurse.
  9. After giving the medicine, disconnect the medicine from the injection cap.
  10. Scrub the injection cap with a new chlorhexidine wipe for 30 seconds and let it dry.
  11. Attach normal saline syringe and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap.
  12. Scrub the injection cap with a new chlorhexidine wipe 30 seconds and let it dry.
  13. Attach heparin syringe and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap.
  14. Clamp the PICC line.
  15. If the catheter is a double lumen, repeat steps 7-19 for the second lumen. Use a new syringe for each lumen.

    Quick reference:

    1. Flush with normal saline.
    2. Give the medicine or fluid.
    3. Flush with normal saline.
    4. Flush with heparin.

How do I change the injection cap?

To prevent infections, the cap should be changed at least twice a week. The home care nurse usually does this, but you may have to change the cap if it starts leaking.

  1. Plan to change the cap at a time when you will be flushing the catheter with heparin.
  2. Prepare the work area (see above).
  3. Wash your hands well (see above).
  4. Gather the equipment:
    • chlorhexidine wipes (2)
    • injection cap (1 for each lumen)
    • sterile gauze (2 for each lumen)
    • sterile drape
    • sterile gloves
    • mask (3)
    • sterile normal saline syringe (1 for each lumen)
    • heparin syringe (1 for each lumen)
  5. Clamp the catheter (each lumen).
  6. Open sterile drape. Only touch the outside edges to keep the middle section sterile.
  7. Open supplies onto sterile drape without touching any of the items inside the packages or touching the packages to the sterile drape.
  8. Put on mask. Masks should be worn by you, your child, and helper.
  9. Put on sterile gloves. After sterile gloves are on, only touch supplies on your sterile drape.
  10. Prepare injection cap. Attach injection cap to sterile normal saline syringe and point them upward to flush the injection cap and remove air in cap.
    • If double lumen, prepare two separate injection caps, each with a sterile normal saline syringe.
  11. Using one piece of gauze pick up the catheter while maintaining hand sterility.
  12. Scrub the connection site (where the old cap joins the catheter) with a chlorhexidine wipe for 30 seconds, using friction. Let it dry.
  13. Pick up new piece of gauze and use it to unscrew the old cap from catheter and remove it.
  14. Inspect catheter hub threads (grooves).
    • If NO debris or blood noted, continue onto step 15 and do NOT scrub the catheter hub threads (grooves).
    • If visible debris or blood noted, with a new chlorhexidine wipe scrub the catheter hub threads (grooves) for 30 seconds, using friction. Let it dry. Do not touch the end of the hub.
  15. Screw on the new cap. Do not touch the end that screws into the catheter. If you do, throw the cap away and use a new one.
  16. Unclamp the catheter.
    • If double lumen, use a piece of gauze to unclamp catheter to keep hand sterile.
  17. Flush the catheter with sterile normal saline and remove syringe.
  18. If double lumen, repeat steps 11-17.
  19. Scrub injection cap with a new chlorhexidine wipe for 30 seconds and let it dry.
  20. Attach heparin syringe tip into the injection cap and flush using the push-and-pause method. When syringe is empty, remove it from the injection cap.
  21. Clamp the catheter.
  22. If double lumen, repeat steps 19-21.

Covering the PICC catheter

  1. The PICC catheter site may be covered with clean gauze. DO NOT apply Coban or other elastic bandages to site!
  2. A clean, laundered sock with toe and leg parts cut off may also be used to cover the PICC site or use cover supplied by pharmacy.
  3. Cover PICC site with plastic wrap while child bathes. PICC site should not get wet!

Cleaning up

Put used syringes into your regular trash. For needles and syringes soiled with blood, use a special sharps container, such as a hard plastic bottle with a screw-on lid. Label it, "Do Not Recycle - Household Sharps."

Do not overfill the sharps container. Disposal varies depending on the area you live in. Some communities have a household sharps collection program. To find out what you should do, check with your garbage collection company, pharmacy, or clinic.

Emergency kit

Take an emergency kit with you everywhere you take your child. Be sure to check the kit before you leave home and replace any used supplies when you return home so it is always ready to go. Supplies include:

  • disposable clamp
  • adhesive bandages
  • chlorhexidine wipes
  • gauze (sterile) and tape
  • injection cap
  • pre-filled normal saline syringes
  • antibiotic ointment

What happens when the PICC line is removed?

The PICC will be removed by a home care nurse or at the clinic. It is not painful. A bandage will be applied.

  • Keep the bandage on and dry for 24 hours.
  • Watch for signs of infection (see problem solving chart).
  • When bathing, do not put the site under water until the wound scabs over.

Solving problems

Problem Possible cause What to do
  • Fever, chills
  • Tenderness, redness, or pus at the catheter site
  • Swollen arm
  • Infection
  • Check your child’s temperature.
  • Call the doctor right away.
  • Trouble flushing the PICC
  • Unable to give medicines or fluid into catheter
  • Catheter may be clamped
  • Catheter or tubing may be kinked
  • Unclamp it (if clamp is present).
  • Remove the kink.
  • If the catheter is not kinked or clamped, do not force the solution into the tube. Call the home care nurse to report the problem.
  • Fluid leaking from the catheter
  • Injection cap not screwed on securely
  • A hole in the catheter
  • Tighten the injection cap.
  • If you see a leak in the line, fold the catheter over and pinch, apply disposable clamp between the damaged area and the skin, and call your home care nurse, clinic, or doctor.
  • Missing injection cap
  • Injection cap became loose and fell off
  • Replace the injection cap using sterile technique and scrub the catheter hub threads (grooves) prior to replacing the injection cap, even if no debris or blood is noted.
  • Skin redness where the tape or dressing was
  • Sensitivity to tape or dressing
  • The nurse may need to change the dressing size or the type of tape or dressing used. Call home care nurse.
  • PICC line accidentally comes out
 
  • Place a sterile gauze pad on the site and press firmly until the bleeding has stopped (2 to 5 minutes).
  • After the bleeding stops, apply antibiotic ointment and a bandage snugly.
  • Save the PICC line and call your doctor or home care nurse.

 

Questions?

If you have any questions, call:

Home care nurse ______________________________________________

Supply company ______________________________________________

Home care pharmacy ______________________________________________

Doctor ______________________________________________


Children's Hospitals and Clinics of Minnesota
Last reviewed 8/2015

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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