Procedure Prep: Take Your PICC

PICC lines are often used for long-term medication or for patients who have veins that frequently “go bad”. What I mean by “going bad” is that these veins often stop working due to being overworked or because the patient has small, thin veins to begin with that collapse the second a small straw (IV) is inserted.

The Difference Between an IV and PICC Line

IV catheters are used for hospital medication and are usually taken out prior to a patient’s discharge. PICC lines can be used in the hospital as well as at home with the proper education given to the patient and family. PICC lines can stay in place for weeks to months depending on the patient’s needs (long-term medication, nutrition, chemotherapy, etc). For a patient that requires repeat blood draws, a PICC line allows the patient to be poked only once for the PICC line placement. Blood can then be drawn directly from their PICC line lessening the amount of pokes a child receives during their hospitalization or illness.

PICC lines are usually inserted in the upper arm and guided through the veins eventually leading to the Superior Vena Cava in the heart. This is completely safe to do as this large vein carries blood throughout the upper half of the body.

Rather than the tiny needle needed to guide the straw into the vein for an IV start, a PICC line uses a guided wire to go through the vein in one’s upper arm all the way to the heart. Because of this, most younger children will be given sedative medication since it’s a lengthy procedure to ensure correct placement. The patient must hold completely still to guide the wire to the correct location near the heart.

How To Prepare Children For Procedure

For older children (school-age and teenagers) with preparation, distraction, and support – the majority of these patients can hold still successfully and follow directions. Some patients even find the ultrasound and technology aspect of the procedure interesting and will engage in conversation with the PICC team members.

The first thing to explain to the child is the reason behind the PICC line. I usually ask the patient why they are needing to have an additional procedure. Some answers from patients include, “My veins keep blowing,” “I need different medicine,” “I get to go home, but need to keep taking my IV medicine.”

We talk about their reasoning and how the PICC line is the solution. I then will show them the long, thin tube that will be carrying their medicine.

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The first and obvious questions are usually

“Where does that go?” or “How is that going to fit?”

I will then talk about the PICC line being similar to the IV in the sense that they both go through the veins. The reason the PICC line is longer is because instead of a “straw” it has a “tube.” In order to keep using the tube repeatedly, we have to make sure it’s in the absolute best vein. The best vein in our body for this is the Superior Vena Cava.

Someone from the PICC team will be coming to insert their tube. I like to share this fact because if I was having something placed near my heart, I would want the certainty that someone does ONLY this job every day. So they must be fairly good at it.

Peripherally inserted central catheter (PICC) insertion using ...

Explaining the Set Up

The first thing the PICC team will do is get the room all set up with their technology. In order to do a PICC line placement, awake and at the bedside, they bring all of their tools and equipment with them. The room can begin to feel very small very quickly so it’s important to prepare the child for all the extra equipment.

The first tool they’ll use is their tourniquet and doppler. This ultrasound doppler allows the PICC team to see and select the best vein.

Transverse probe position to approach peripheral IV access with ...

Next they’ll measure, using a paper measurement stick from the approximate site of their chest to their arm. This allows them to give the best guess for about how long they’ll need their wire guide to be and ensure they’re in the correct spot.

2020 1 Meter 40 Paper Tape Measure Disposable Paper Measuring Tape ...

Another piece of equipment that the PICC team may use is this device shown below. The life jacket looking object over this boy’s chest is actually a tip locator used to distinguish if the PICC line is inserted correctly in the lower section of the Superior Vena Cava. Most patients will require a bedside Xray prior to official use of their PICC line.

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The Finale

So far, sounds like a lot of set up. So what’s the trouble?

Due to the risk of infection, the set up and cleaning process is extensive. It’s imperative that the child is able to hold still on their own as a comfort position is not possible in this procedure. Distraction and support are of huge importance for this procedure, especially when the child is awake.

The child will feel a cold wetness as the PICC team member cleans the area once a vein is selected. Then Lidocaine (a local anesthetic) is used as an injection to quickly numb the area. When explaining this poke to children, I will be honest that the shot feels like a poke, but progressively gets better the more numbing medicine they’re able to inject. I will usually tell them that within 10 seconds the pain should subside.

For distraction, counting seems to help redirect and gets the child to focus on something else.

Once the poke is complete – the hard part is over! The guided wire will move through the numbed area and into the vein. The most the child will feel is pressure. The way I explain this is like swallowing. If you really focus on your swallowing, you’ll feel the pressure of your spit moving down your neck. The guided wire may feel like that your vein, but it should not hurt. Once the PICC line is in the correct spot, tape and bandages will be placed on top of it to keep it secure.

Like I said, preparation, distraction, and support are of utmost importance. Honesty and following the child’s lead will help this procedure go as smoothly and painlessly as possible!

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