Peripherally Inserted Central Catheter (PICC) in Children: Care Instructions

Overview

A peripherally inserted central catheter (PICC) is a thin, flexible tube that's used to give medicine, blood products, nutrients, or fluids. One end is put through the skin into a vein in the arm and moved into a large vein near the heart. The other end stays outside the body. It's a type of central vascular access device, or central line.

Your child may have it for weeks or months.

A PICC can be more comfortable for your child because medicines and other fluids go directly into the catheter. That means your child won't be poked with a needle every time. A PICC also can be used to do blood tests.

The end of the PICC sometimes has two or three openings so that your child can get more than one type of fluid or medicine at a time. It may allow you to help treat your child at home.

The doctor may give your child a sedative to make your child feel relaxed. Your child may feel a little pain when the doctor gives the sedative or numbs your child's arm. The doctor will then thread the catheter up a vein in your child's arm to a larger vein. The doctor may use stitches or other devices to hold the catheter in place where it exits the arm.

After the procedure, the site may be sore for a day or two. Your child may have a large bandage or other covering to help keep the PICC clean and in place.

How can you care for your child at home?

• Always wash your hands, and have your child wash their hands, before you touch the catheter.
• If the catheter breaks, follow the instructions your doctor gave you. If you have no instructions, clamp or tie off the catheter. Then take your child to a doctor as soon as you can.
• To help prevent infection, have your child take a shower instead of a bath. Your child should not go swimming with the catheter.
• Try to keep the area dry. When your child showers, cover the area with waterproof material, such as plastic wrap.
• If your child's catheter has a clamp, keep it clamped when it's not in use.
• Fasten or tape the catheter to your child's body to prevent pulling or dangling.
• Avoid clothing that rubs or pulls on your child's catheter. Have your child be careful wearing jewelry, such as necklaces, that can catch on the catheter. Put loose clothing over the catheter for the first 10 to 14 days. When getting your child dressed, be careful not to pull on the catheter.
• Show your child how to avoid bending or crimping the catheter.
• Never touch the open end of the catheter if the cap is off.
• Never use scissors, knives, pins, or other sharp objects near the catheter or other tubing.
• Don't have your child's blood pressure taken on the arm with the catheter.

Changing the dressing

• Change your child's PICC dressing at least once a week. If the dressing gets loose, wet, or dirty, it must be changed more often to prevent infection. The doctor may give you more instructions for when to change the dressing.
• Be sure you have all your supplies ready. These include medical tape, a surgical mask, sterile gloves, and your dressing kit. The names and brands of the items will vary. The doctor or nurse may give you specific instructions for changing the dressing.

How to change the dressing

If you did not get instructions from your doctor, here are some basic tips for how to change the dressing.

1. Wash your hands with soap and water for 15 to 30 seconds. Dry your hands with paper towels.
2. Put on the surgical mask.
3. Loosen and remove your child's old dressing. Peel the dressing toward the PICC, not away from it. You may need to use an adhesive remover if the dressing doesn't come off easily.
4. Look at the site carefully for redness, swelling, drainage, tenderness, or warmth. If you notice any of these, call the doctor.
5. Prepare to replace the dressing. Wash your hands again, and open the dressing kit. Put on the sterile gloves.
6. Clean the site with the supplies in the dressing kit.
7. Place the new dressing over the site.
8. Tape the PICC tubing to your child's skin so that it doesn't dangle or pull.

How do you flush the line?

A PICC line must be flushed to keep it clear of blood and prevent clotting. Do this as often as your doctor tells you to. If it has more than one line (lumen), flush them in the same order each time.

Depending on the type of PICC line your child has, you will flush it with either heparin or saline solution. Your child's doctor or nurse will probably give you supplies and instructions on how to flush it. A nurse may come to your home to help at first.

Your child will usually lie down when you flush the line. This helps prevent air from getting into the vein.

1. Prepare the syringe or cannula.
   1. Be sure you have all your supplies ready.

      These may include the heparin or saline solution, syringes, needleless injection cannulas, alcohol swabs, medical gloves, and a disposal box. What you need will vary with the type of PICC line your child has. You may have syringes that are already filled with the solution (preloaded).

   2. Wash your hands with soap and water for 15 to 30 seconds.

      Dry them with paper towels. Put on medical gloves, if your doctor told you to.

   3. Wipe the stopper of the heparin or saline solution bottle with an alcohol swab for 15 to 30 seconds.
   4. Remove the cover from the syringe, and twist the needle or cannula onto it. (It may already be attached.)
   5. Remove the cover from the needle or cannula.

      If you have a preloaded syringe, skip to step 2, "Flush the PICC line."

   6. Pull back the plunger of the syringe.

      Draw air into the syringe equal to the amount of heparin or saline solution you are using.

   7. Push the needle or cannula through the rubber lid of the solution bottle.
   8. Push the plunger of the syringe to force air into the bottle.
   9. Turn the bottle and syringe upside down.

      Position the tip of the needle or cannula so that it is below the surface of fluid in the bottle. Pull back the plunger to fill the syringe with the amount of solution you need.

   10. Before you take the needle or cannula out of the bottle, check for air bubbles in the liquid in the syringe.

       If there are bubbles, push the plunger back in and then pull back on it again.

   11. Remove the needle or cannula from the bottle.
   12. Fill other syringes if you need to flush more than one lumen.
2. Flush the PICC line.
   1. Use an alcohol swab to rub the cap of the lumen you want to flush.

      Rub for 15 to 30 seconds, and then let the cap dry.

   2. Hold the end of the PICC line so it doesn't touch anything.
   3. If there's a clamp on the lumen, open it.
   4. Slowly inject the heparin or saline solution.

      If there is resistance, stop. Don't force it. Call your child's doctor.

   5. Remove the syringe, and clamp the catheter.

      If your child's PICC line has a clamp, clamp the lumen as you finish the injection. Then remove the syringe. If the PICC line has a positive pressure cap, remove the syringe and then clamp the catheter.

   6. Put the syringe in the disposal box.
   7. Repeat the above steps for each lumen you are flushing.
   8. Wash your hands again with soap.