Why You Are Being Discharged with a PICC
You are going home with a peripherally insertion central catheter (PICC). This thin, small tube is 18-24 inches long and ends in the large vein near your heart. It is often used when treatment requires medicines or nutrition for weeks or more. At home, you need to care for your PICC to keep it working and help prevent the spread of germs. This sheet will help you remember how to care for your PICC at home.
Caring for Your PICC
Hand-Washing: When caring for your PICC and touching any supplies, you should wash your hands and put on clean gloves. These steps help prevent infection.
If hands do not look dirty, you can use an alcohol-based product such as Purell® gel. Rub it well, all over your hands, front and back, until dry.
If hands look dirty, use soap and water. Wash well, for at least 15 seconds. Use a new, clean towel or paper towel to dry hands well.
Nails: Fake nails can increase the risk of infection. Keep your nails short, trimmed and clean.
Activity: Always protect your PICC. Avoid rough activities.
Supplies: When you go home, supplies and equipment may be delivered by your home care agency. To order more supplies, contact your home care agency.
Flushing Your PICC
If you get medicines while at home, your home care agency will teach you how to care for the PICC.
Flush your PICC every day and after each use. Your nurse may tell you to flush more often if needed.
1 – prefilled 5mL heparin syringe (10 units/ml) per lumen (if ordered)
1-prefilled 10ml saline syringe (if told to not use heparin)
Steps for Flushing Your PICC
Clean work area.
Put on gloves.
Scrub the hub of the needleless connector with an alcohol wipe for 15 seconds. Allow hub to dry and do not let it touch anything. Attach and flush syringe. If anything touches the hub before you attach the flush syringe, stop and scrub the hub again for 15 seconds.
To prepare the flush, remove from the plastic wrapper. Remove the plastic cover from the tip of the syringe. There is a small amount of air in the syringe. Point the syringe up, and gently push the air out of the syringe.
Connect the syringe filled with heparin or saline to the hub of the needleless connector. Twist on.
If the tip of the syringe touches anything other than the end of the PICC, stop, and replace the syringe.
Unclamp the PICC.
Begin flushing using a “push-pause method” on the syringe plunger. Push the contents of the syringe into the PICC, leaving a small amount of fluid in the syringe.
Note: the PICC should flush easily. If you find it hard to push the fluid in, check to make sure the clamp is open and that the PICC is not kinked. If it is still hard to push the fluid in, do not force the plunger. Call your home care agency.
Follow the instructions your clinic or home health nurse gave you to throw away the used supplies.
If you have more than one lumen, repeat steps 5-11 for each lumen.
Changing the Needleless Connector
Change the needleless connectors at least every week. A good time to change it is when you change the dressing.
Pre-filled normal saline (10mL syringe) or heparin 10 unit/1mL syringe (5mL in a 10mL syringe)
Steps for Changing a Needleless Connector
Use soap and water or cleaning wipes to clean a table or counter. Dry with a clean towel or paper towel.
Put on clean gloves.
Make sure the PICC is clamped.
Remove plastic cover from the syringe. Do not touch end of the syringe.
Firmly insert and twist the syringe into the clean needleless connector. Be careful not to touch the end of the needleless connector to anything other than the syringe.
Push the syringe slowly until the saline or heparin comes out the end of the needleless connector. Keep syringe attached.
Remove the light blue tip from the end of the new needleless connector. Do not allow that end to touch anything.
Remove the old needleless connector from the PICC. Do not touch the end of the lumen.
Place the new needleless connector on the end of the PICC. Secure the needleless connector by twisting it on. Make sure it is secure and tight. Do not over-tighten.
Unclamp the PICC.
Flush normal saline or heparin into the PICC using a “push-pause method” 1 mL at a time.
Clamp the PICC.
Remove the syringe from needleless connector.
Throw away the supplies.
Showering with a PICC
Tap water has germs that can cause infection and should not touch your PICC. The site must remain dry when you shower.
Always cover your PICC, even if you plan to change the dressing after.
Use extra plastic to cover the PICC. You can use Glad Press’n Seal® or a plastic bag.
Keep your back facing the water to keep soap and water away from the PICC and lumens.
Clear plastic cover
Steps to Cover PICC During Shower
Remove a piece of plastic cover or bag to cover your PICC.
Apply the plastic cover over the entire dressing, lumens and any tubing.
Use the tape to help seal any edges and make sure it is sticking well to your skin.
When you are done with the shower or bath, gently remove tape and plastic cover off skin.
Make sure dressing is dry and intact.
If dressing is wet or loose, contact your home care agency or call your doctor.
Problems with the PICC
Break in the Line: Clamp the line above the break and cover with a sterile dressing.
Never use scissors or sharp objects near the PICC. Only use padded rubber-tipped hemostats, blue plastic hemostats, or the clamp that comes attached to the PICC.
Comes out: If the PICC comes out, apply pressure with a sterile gauze pad right away to the exit site for about five minutes. Then place a transparent dressing over the gauze on the exit site.
If the PICC comes out a bit from the body, do not push it back in.
Leaks: If the PICC is leaking, clamp the PICC with a hemostat between you and the leak.
When to Call
Call your doctor right away if you have any of these issues:
Fever of 100.4° F (38.0° C) or higher.
Swelling of chest, neck, face or arm.
If the PICC will not flush or draw blood.
Pain, redness, or swelling at the site.
If the PICC breaks, comes out or is leaking.
Terms to Know
Peripherally Inserted Central Catheter (PICC): A PICC is a thin, flexible, hollow tube placed in a vein. A vein above the elbow is usually used. The PICC is 18-24 inches long. It ends in the large vein near your heart. There may be one, two, or three lumens (IV access lines) at the end of the PICC. This is where your medicine will be given and blood for lab tests may be drawn.
Needleless Connector: The needleless connector (also called the hub) is the one-inch clear plastic piece. You can see this part at the end of the PICC. The needleless connector keeps the PICC closed and helps keep air and germs out of your body. Your PICC should always have a needleless connector on each lumen.
Scrub the Hub: This refers to cleaning the needleless connector. Use an alcohol swab and wipe the hub for 15 seconds. When finished, let it dry for 15 seconds before use.
Flushing: Flushing the PICC refers to using saline to clear anything that still may be in the PICC such as blood, medicine or nutrition.
Locking: Locking the PICC refers to putting heparin or saline in the PICC when it is not being used. The PICC should also be clamped when it is not being used.
Push-Pause Method: This a method you can use to flush your PICC to keep it clear of any blood, extra medicine or nutrition. Instead of a steady push, you should start (push) and stop using the push-pause method.
SASH: SASH stands for saline-administer (medicine)-saline-heparin. This helps you remember the order of giving medicine as well as flushing guidelines for your PICC.
SAS: SAS stands for saline-administer (medicine)-saline. Some patients may be told to not use heparin. This will help you remember the order of giving medicine as well as flushing guidelines for your PICC.
Securement Device: Your PICC is held in place by a special device. This locks the PICC in place to keep it from coming out. A common device is called a StatLock®.