PICC Nurse Procedures

A PICC, or peripherally inserted central catheter, is a flexible plastic tubing that is put in a patient's arm for intravenous (IV) access. It has one or more lumens. Multiple lumens allow fluids such as antibiotics, chemotherapy or blood to be infused at the same time. A PICC may be left in place for extended periods of time, from several months to a year. After the PICC is inserted, a nurse confirms placement before accessing it.

Confirmation of the PICC

• A physician or a trained IV nurse inserts the PICC through a vein in the patient's arm. It is advanced until it reaches another vein above the heart. A chest x-ray is ordered to make sure the PICC is in the right spot, and the nurse checks the X-ray report prior to using the line. If the x-ray shows that the PICC is not in the vein above the heart, it must be repositioned.

Accessing the PICC

• When accessing the PICC, the nurse wipes the lumen with an alcohol pad. She then attaches an empty syringe to the lumen, gently pulls back 10 mL blood and discards the syringe. Wasting 10 mL of blood prevents the circulation of tiny clots that may have formed at the tip of the PICC. The nurse then flushes the lumen with 10 mL of saline to clear blood from the line before attaching the IV tubing so the patient can receive his medication.

Drawing Blood

• When using the PICC to obtain blood specimens, the nurse wipes the lumen with alcohol and attaches an empty syringe to waste 10 mL blood. She then attaches another syringe to collect blood samples that will be sent to the lab. Afterwards, the nurse flushes the lumen with 10 mL of saline.

Flushing and Heparinizing the PICCs

• PICCs can become occluded, making it difficult for the patient to receive antibiotics and other IV therapies as scheduled. Specially trained IV nurses declot the line by instilling anticoagulants and removing them after a certain amount of time. The staff nurse prevents clotting by flushing PICC lumens with 10 mL saline after each use. Routine heparin flushes are also done at some facilities.

Changing Lumen Caps and PICC Dressings

• The caps at the end of the lumen and the PICC dressing must be changed routinely to prevent infection. Lumen caps are changed more often if they contain trace amounts of blood. PICC dressings cover the insertion site and protect it from bacteria, dirt and other contaminants. They are changed according to hospital policy. However, if the dressing is wet or if the adhesive becomes loose, the nurse should change it immediately.