Drawing Blood From a Single Lumen Picc Line

How Do You Care For a PICC?

A PICC is a peripherally inserted central catheter. This special IV is placed into a large vein in the upper arm and sometimes in the leg of an infant. The end of the PICC ends in a vein close to the heart but not in the heart.

• The PICC can stay in place for several months.
• The PICC can be a single or double lumen line. A single lumen PICC has one tubing and one cap on the end. A double lumen PICC has two separate tubings and two caps.
• A PICC is used to give medications, fluids and IV nutrition. If the PICC is big enough, it can be used to draw blood.

How a PICC Is Placed

The PICC is placed in the radiology (X-ray) department or at the bedside if the child is too sick to go to radiology.

• A nurse and a child life specialist talk with you and your child to explain how it is done.
• Most children are awake for the procedure.
• Steps are taken to make sure your child is as comfortable as possible.
• An X-ray is taken to make sure the PICC is in the right place.

Caring for the PICC at Home

A home care infusion company will give you the supplies needed to care for the PICC at home.

• The PICC is flushed at least two times a day to keep it from clotting. You are taught how to do this by a nurse from your home care infusion company.
• The PICC dressing keeps the site clean and holds the PICC in place. The PICC dressing and cap are changed weekly by a nurse. Someone needs to help hold your child still for the dressing change.
• If the dressing comes loose and is not covering the PICC, call the home care nurse to change the dressing.
• Keep the PICC covered at all times with a protective wrap. This keeps the PICC from being tugged or pulled. The protective wrap is only removed when the PICC is being used.
• Keep the PICC dry during bathing. You can cover it with plastic wrap or a plastic bag to keep the dressing dry.
• Anyone who takes care of your child needs to learn about the PICC. They need to know how to take care of the PICC, how to recognize any problems, and what to do should a problem come up.
• The PICC is taken out by a nurse at the end of therapy. This can be done in the home or clinic.

Safety Guidelines for a PICC

• Keep a protective covering or wrap around the PICC.
• Keep the PICC dry at all times.
• Avoid activities that could cause damage to the PICC. This includes contact sports. Ask your home care nurse if you have any questions about an activity.
• Avoid activities that may cause sweating. Sweating may cause the PICC dressing to come off.
• Your child can return to school with a PICC. Your home care nurse will contact the school to make plans for your child to go to school with a PICC.
• Keep an emergency kit with your child at all times. The emergency kit should have tape, gloves, clamp and gauze.

Possible Problems with a PICC

• Infection
• Blocked or clotted PICC
• Bleeding
• PICC dislodged
• Hole or tear in PICC
• Phlebitis (irritation of vein)
• Movement of the PICC
• Air in bloodstreams

Signs of a Problem with a PICC

Infection

Signs of a skin infection include:

• Redness
• Drainage
• Pain
• Swelling
• Warmth

Signs of a bloodstream infection include:

• Fever
• Chills
• Sweating
• Drowsiness or dizziness
• Feeling sick

Blocked or clotted PICC

• Blood can clot inside the PICC and cause it to be blocked.

You would know the PICC was blocked if:

• The PICC becomes very hard to flush or you cannot flush it at all
• An IV solution will not go in through the PICC

Bleeding

• Some bleeding after a PICC is put in is normal. If the bleeding makes the dressing not stick, call your home care nurse to get a dressing changed.

Movement of the PICC

Loose Dressing

• The PICC is held in place with tape, a securing device and a clear dressing.

• The PICC can move in or out if any part of the dressing comes loose.

Call your home care nurse if you think this might have happened.

PICC gets tugged or pulled

• The PICC could be pulled out some or all the way.
• If the PICC is pulled all the way out:
• Apply pressure for any bleeding
• Save the PICC
• Call the home care nurse
• If the PICC is pulled out some of the way:
• Tape the PICC in place
• Call the home care nurse
• This could also cause a hole or tear in the PICC. Signs include:
• Wetness under the dressing
• Puffiness or swelling at the PICC site

Phlebitis

This is irritation of the vein in which the PICC is in. It is not an infection. Signs include:

• Redness or hardness along the vein with the PICC
• Pain in the extremity with the PICC
• Swelling at or near the PICC site

Movement of the PICC

• The PICC is held in place with tape, a securing device and a clear dressing.
• The PICC can move in or out if any part of the dressing comes loose.
• Call your home care nurse if you think this might have happened.

Air in the bloodstream

This is very rare. But it could happen if the cap came off the end of a PICC that is not clamped. It could also happen if there was a cut or tear in the PICC. It takes a large amount of air in the bloodstream to cause a problem. If air gets into the bloodstream, your child could have:

• Trouble breathing
• Chest pain
• Coughing

If There Is a Problem with a PICC

Call the doctor or nurse if your child has:

• A fever
• Chills, sweating, drowsiness and feels sick
• Trouble breathing or chest pain
• Any redness, swelling, pain or drainage around the PICC
• Wetness under the PICC dressing
• Rash, itching or hives

How to Prevent a Problem with a PICC

• Wash your hands before doing any PICC care.
• Always keep a clean, dry, occlusive (all edges sealed) dressing over the PICC site.
• Follow the instructions for cleaning the cap and using sterile equipment.
• Avoid tugs or pulls on the PICC. Take extra care when removing clothing to avoid a pull or tug.
• If the PICC is hard to flush, do not try to force it.
• Always keep scissors and all sharp objects away from the PICC.
• Make sure the PICC is covered and secure when your child is sleeping.

Drawing Blood From a Single Lumen Picc Line

Source: https://www.cincinnatichildrens.org/health/p/picc

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