What’s a PICC Line?

A PICC (Peripherally Inserted Central Catheter) is a type of central line, or an IV (intravenous) line that remains in your body for extended periods of time. Most PICC lines are inserted in the upper arm, and the catheter is threaded through a vein that leads to the heart.

How We Decided I Need One

My PICC line was inserted in March. I was very sick throughout the fall winter and early spring of this year. I developed dysphagia (difficulty swallowing), and persistent nausea and vomiting. I lost about 30 lbs from October-January. I received twice weekly infusions of IV fluids at a hospital infusion center for four months to keep me from dehydration and to help with my Dysautonomia/POTS which is deeply impacted by my ability to stay hydrated. Eventually it became difficult to find IV access, and in March when I needed IV migraine treatments at home, my home health nurse stuck me 20 times over 3 days and I still wasn’t able to finish my treatment because typical IV lines (Peripheral) were difficult to get in, and blew within hours and became unusable. We decided to go with a PICC line to allow me to trial more frequent fluids, and to do them at home. It also allows for IV access when I need medication, but it is not without its risks. The main risks associated with central lines are infections and clotting. 

Why not just drink more water?

Sometimes, I can’t. Things have gotten better since the beginning of this year but there are still days when my nausea wins out.

Also, in people with POTS, there is often hypovolemia, or low blood volume. This means that even IF I am hydrated, my body may not properly allocate hydration to my blood. I take medication to help me retain fluid, but a lot of it still runs through me. Before I developed dysphagia and intractable nausea, I was drinking 80 to 100 ounces of water and electrolyte fluids. That’s just not possible anymore. 

My PICC line has significantly improved my quality of life. I don’t have to worry quite as much about whether or not I am getting enough oral fluids. I am not falling regularly like I was before, and am able to be much more active and upright more frequently. The combination of dehydration and my POTS was making me extremely unsteady before my line. It also allows me to administer IV medications when necessary.

What Getting a PICC Line Feels Like:

Getting a PICC line is a simple procedure, but it does need to be sterile, and is usually inserted in the hospital. For insertion, some people are asked to put on a gown, while others are allowed to stay in their clothes. I kept my pants on and wore a gown on top.

A radiologist, or nurse with special training will clean and drape the area. They will then use portable ultrasound in order to find a suitable vein, and most likely place the line in your dominant arm. Local anesthetic will be used to numb the insertion site (If you have EDS, and need extra or a particular kind, speak up!). The line is threaded through the vein and into the superior vena cava with a thin wire. This is not painful, but it is a weird sensation! Once the line is in place, they will secure the line and put a sterile dressing over it (If you can not tolerate typical adhesive clear dressings like those that go over an IV, talk with your home health company about ordering a hypoallergenic or silicone dressing to bring with you). You will have a chest XRay before going home to ensure that the line is placed correctly.

After my insertion I was really sore and pretty swollen and bruised in the area for about a week. Since then, I don’t feel my line at all. I do deal with itching and skin irritation from the dressing and the solution used to clean the site each week.

Line Care:

To minimize the risk of infection, it is essential to learn how to properly care for your PICC line. The sterile dressing must be changed once a week. My home health nurse does this for me, but I have also learned to do it so that I know what to do in an emergency. It is important that if you react to a particular dressing to keep trying new ones until you find one that works with your skin. I have had luck with IV 3000 and IV Clear dressings.

Figuring out what works for your skin can be trying, but it’s important because excessive skin break down or blistering can lead to infection. I use a STATLOCK to secure my line, and a biopatch to help deter infection at the insertion site. I also use a swabcap (orange cap) at the end of my line each time I finish using it, which sterilize the tip of the line and provide a barrier to prevent germs from entering the line while its not in use.

To minimize the risk of clotting and keep the line in working order it is important to use a SASH protocol. This means flushing the line with saline before administering fluids or medication, and flushing it again with saline and then heparin when you are finished. This last part is called locking the line.

In order to keep your PICC line out of the way, and keep it from catching on things it is best to have a PICC sleeve. My favorite one is the PICC Perfect from Mighty Well, a company that was started by patients for patients (I have no relationship for Mighty Well, this is not a sponsored post – I just happen to think they are awesome). I like it best because it has a dual layer of fabric that keeps the line off of your skin. That means for me, it helps prevent some of the itching associated with having a line and a mast cell disorder.

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