Peripherally Inserted Central Catheter (PICC): Care at Home

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Going home with a Peripherally Inserted Central Catheter (PICC) line

Your child will be going home with a peripherally inserted central catheter, a PICC line. You will learn how to use and care for the line, which will include ways to prevent infection, flushing, solving problems and may include giving medicine through it.

Your child's catheter:

___ Power injectable

___ One lumen                   Other: ___________

___ Two lumens                 Blood samples can be taken from the PICC:  Yes / No

How should I care for my child?

As your child improves and is able to be at home, nurses will teach and help you become comfortable with the PICC line and care before you do them yourself. The hospital staff will lead and supervise line cares any time your child is in the hospital.

These are the things you will need to learn before going home:

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

Preventing infection

PICC lines are helpful for taking care of your child, but 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, of the PICC line may need to be removed. There are things you can do to prevent a PICC line infection.

Cleanliness is a must!

1. Clean your hands with an alcohol-based sanitizer or wash with soap and water before caring for your child's PICC line. This means washing your hands before doing any of these:
   • Flushing the PICC line, giving medication, and any time handling the PICC line.
2. Clean solid surface work areas with a disinfectant (such as Lysol® or another brand) when preparing to do PICC cares.
3. Bathing
   • Cover PICC site and line(s) with plastic wrap or waterproof dressing while your child bathes or showers. The PICC site should not get wet or be placed in the water. If the transparent dressing becomes wet, call the home care nurse so it can be replaced right away.
   • Do not let the PICC line drop down into the bath water, as germs from the water may enter the end of the line. Bathing in hot tubes should be avoided.
4. Keep the PICC line out of the diaper area when changing the diaper, and do not allow your child to put the line(s) in their mouth.
5. The PICC site and line(s) may be covered and protected with a clean, laundered sock with the toe part cut off.
6. Look at the PICC site and look for signs of infection (see Solving Problems).

Can my child bathe/shower?

Once your doctor or nurse approves bathing and showering, take care and protect the line by protecting the dressing and lines with a waterproof covering. If the dressing becomes wet, replace it right away.

Do not let the catheter lines drop down into the water, as germs from the water may enter the catheter. Do not bathe in hot tubs.

Can my child go swimming?

While your child has a PICC line, swimming in oceans, lakes, rivers, pools, and hot tubs is discouraged. There have been reports of serious infections after swimming. There may be times when your provider and you as caregivers would allow it but it should be discussed with your medical team. If the decision is made to allow swimming, the PICC line should be covered with a waterproof dressing and the dressing and caps should be changed immediately after coming out of the water.

Flushing the PICC line

When should I flush the PICC line?

The PICC line must be flushed to prevent blood from clotting (building up) and blocking it. If the line becomes blocked, it may need 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 medicine(s) or fluids.
• After drawing blood.
• If your child weighs over 17 pounds, flush the line every 12 hours each day. 
• If your child weighs under 17 pounds, flush the line every 8 hours each day.

How do I flush the PICC line?

Important notes about flushing:

• Always use 10mL or larger syringes. A smaller syringe may push too much pressure into the line and cause it to break.
• Before each time you flush or put any medicine into the PICC line, put on non-sterile gloves and scrub the injection cap for 15 seconds with a new Chlorhexidine gluconate (CHG) wipe, using friction. Allow to dry for 15 seconds and until completely dry. Do not blow on or fan the area.
• Every time you flush, 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.
• If it is difficult to flush the PICC line or give medicine through it, do not force it to flush. Call your doctor or home care nurse for help.

Quick Steps to Flush: 1. Scrub 2. Flush with normal saline 3. Scrub 4. Flush with heparin, if ordered 5. Clamp PICC line

Steps

1. Prepare and clean work area
2. Wash your hands well.
3. Gather supplies: 
   • non-sterile gloves
   • CHG wipes
   • normal saline syringe (1 for each lumen)
   • heparin (if ordered, 1 for each lumen)
4. Check the normal saline and heparin syringe labels before giving them.
   • Normal saline and heparin syringes are good until the expiration date. Throw it away sooner if you see sediment in it or if you question its cleanliness. If you throw one away be sure to call the home care pharmacy for a replacement.
5. Put on non-sterile gloves.
6. Prepare pre-filled normal saline syringe(s) by removing the air bubble in them. Remove cap. Hold syringe with tip up. Pull back slightly on the plunger and then push plunger gently squirting the air bubble out. Place cap back on the syringe.
7. Scrub the injection cap with a CHG wipe for 15 seconds. Allow to dry for 15 seconds and until completely dry.
8. Attach normal saline syringe tip into the injection cap.
9. Unclamp the catheter.
10. Flush with normal saline using the push-and-pause method. When syringe is empty, remove it from the injection cap.
11. Scrub the injection cap with a new CHG wipe for 15 seconds. Allow to dry for 15 seconds and until completely dry.
12. If heparin is ordered, attach the heparin syringe tip into the injection cap and flush using the push-and-pause method. When the syringe is empty, remove it from the injection cap.
13. Clamp the PICC line.
14. If the PICC line is a double lumen, repeat steps 6-13 for the second lumen. Use new CHG wipes, normal saline and heparin syringes for each lumen.
15. Put used syringes and supplies into your regular trash. For syringes with blood, use a special 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.

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). Check for a kink in the line. 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 catheter, clamp it between the damaged area and the skin. Call the home care nurse, clinic, or doctor.
Missing injection cap	Injection cap became loose and fell off	Immediately clamp the line, if open. Scrub the catheter hub threads with a CHG wipe for 15 seconds and allow to dry for 15 seconds and completely dry before putting on a new injection cap. Call the home care nurse, clinic, or doctor.
Skin redness where the tape or dressing is	Sensitivity to tape or dressing	Call home care nurse. The nurse may need to change the dressing size or the type of tape or dressing used.
PICC line accidentally comes out		Place a sterile gauze pad on the site and press firmly until the bleeding stops (2 to 5 minutes). Apply a bandage. Save the PICC line and call your doctor or home care nurse.

Emergency kit

Take a PICC line emergency kit with you everywhere your child goes. Check the kit before you leave home and replace used items when you return home so it is always ready to go. Supplies include: 

• adhesive bandages (Band-Aid™) 
• chlorhexidine (CHG) wipes
• clamp
• injection cap
• normal saline syringe
• sterile gauze
• Tegaderm®  dressing
• tape

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.

Questions?

If you have any questions, call:

Home care nurse ______________________________________________

Supply company ______________________________________________

Home care pharmacy ______________________________________________

Doctor ______________________________________________

Last reviewed 4/2023 by Vascular Access and Home Care

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