Thank You Dr. Gaur for Sharing More On PICC Lines!

We reached out to Dr. Gaur, a diagnostic and international radiologist, in training, practicing since 2011, to answer a few questions on PICC lines, why they are used and what patients can expect.
Dr. Gaur has been published in major radiology journals.  He has presented his research numerous times at the national radiology society meetings and has been featured in the New York Times.  He is a member of the ACR (American College of Radiology), ABR (American Board of Radiology), RSNA (Radiological Society of North America), and SIR (Society of Interventional Radiology). 
Dr. Gaur is currently developing video modules based on his radiology education. Thank you Dr. Gaur for taking the time to share more with the Care+Wear community!

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What is a PICC line and why do I need it?


A PICC line is a special type of catheter (a thin hollow plastic tube) that allows a patient to receive IV treatments such as antibiotics, chemotherapy, and pain medications.  PICC stands for Peripherally Inserted Central Catheter and refers to the fact the catheter is placed peripherally (in an arm vein) with the tip of the catheter located centrally, as in a central vein in the body.  PICC lines are placed when patients need IV treatments for a duration of weeks to months.  

 

 

 

Why can’t I receive my IV treatments through a regular IV?

A standard IV, also known as peripheral IV or PIV, is a short flexible catheter (hollow plastic tube) usually placed in a superficial vein the “antecubital fossa” (the small depression where the arm bends at the elbow).  A peripheral IV is usually OK for treatments for up to 1-2 weeks.

The problem with peripheral IVs is that eventually the vein reacts to the presence of the catheter and closes down.  An MD or RN will become aware of this problem when the IV fails to aspirate blood and/or flush forward properly.  

PICC lines avoid this problem because they are long plastic tubes that extend all the way from the upper arm vein to the “Superior Vena Cava”, a large vein which empties directly into the right side of the heart (where all venous blood eventually drains).  IV treatment infused into the catheter will pour directly into this large vein and then be pumped throughout the body within a few heartbeats.


What does “central catheter” mean?

A. Central refers to the fact that the tip of the catheter is in a central vein, usually the “superior vena cava” a large vein draining into the right-sided chambers of the heart.  

Knowing that a catheter is “central” is important if the medication that is being delivered is toxic to veins.  For example, chemotherapy has toxicity (as it kills cancer cells) and, if infused through a peripheral IV, will cause damage to the vein as it flows towards the right side of the heart.

However, if chemotherapy is infused through a PICC it will emerge only within the “central veins” and immediately be pumped throughout the body.  This prevents damage to the vein and also allows the treatment to be bio-available throughout the body.

 

Who places PICC lines in the hospital?

Traditionally, physicians working in the Interventional Radiology (IR) departments in hospitals place PICC lines.  Other services that can perform this procedure including Vascular Surgery, Pulmonology, and Physician Assistants (PA) or Nurse Practitioners (NP) working in any of these departments.

 

Is having a PICC line placed safe?  What is the worst that could happen?

The chance of having a life threatening complication during a PICC line placement is exceedingly low, probably occurring much less than 1% of the time.  Personally, I have never seen anyone severely harmed during a PICC placement.  That being said, reported adverse events include severe bleeding, injury to blood vessel or nerve, air entrance into the bloodstream (air embolism), and arrhythmia (irregular heartbeat).  

During the lifetime of the catheter, there is a ~5% risk of infection of the device and a ~ 5% risk of thrombosis (development of clotting of the vein).  These are not necessarily life-threatening but could require removal of the device and additional treatments.  You will be advised how to keep the device clean and when you should report to a doctor.


What is the PICC line procedure like for a patient?

The procedure is performed in a sterile operating room or procedure suite.  The patient will be lying on their back on a narrow table with the arm extended on a board.  

The physician will use lidocaine to numb a spot on the upper arm and access the arm vein using an Ultrasound machine. You will then move under a large X-ray camera that will take pictures to document the placement of the catheter within the body.  

Usually no IV sedating medications are necessary and the patient is awake the whole time.  The procedure takes about 45 minutes and patients can leave same day.  The catheter is ready to use immediately after placement. 

Aside from the discomfort associated with the placement of the numbing medication, most patients experience no pain during the procedure.

 

Can I live at home and go to work with a PICC line?

The answer is yes.  In fact, over the past 5-10 years there has been a push to have patients receive PICC lines in order to obtain IV treatments at home with the help of a visiting nurse.  This helps keep patients out of the hospital and reduces the risks of developing hospital associated infections and blood clots. It is also cheaper for the healthcare system and provides patients the benefits of IV medications with the freedom of outpatient treatment.

There are precautions to take when living at home with a PICC line.  These include keeping the catheter site clean with a sterile occlusive dressing at all times, keeping the site covered and dry during showers, and regular flushing to prevent blood from clotting within the catheter.  

 

Where can I go for additional information?

I encourage patients to direct all questions to an experienced interventional radiologist or interventional radiology RN prior to their procedure.  Patients should feel comfortable with this helpful device that is implanted within the body.   

Thank you Dr. Gaur for taking the time to explain more about PICC lines! 

For more information about PICC lines, please check out Dr. Gaur's video blog at: https://www.youtube.com/user/sarelgaurMD



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