Peripherally inserted central catheter (PICC) Placement

What is a PICC placement?

During PICC placement, a long, soft catheter is placed directly into a vein above the elbow and the tip of the catheter is positioned in a large vein near the heart. The PICC is used for giving IV fluids, medicine, total parental nutrition and sometimes blood can be drawn. Once it’s placed, the PICC can stay in your child’s body for several weeks to months.

The placement of the PICC is done under image guidance, which means that we use ultrasound and fluoroscopy to facilitate the precise placement of the catheter tip in the desired central vein.

When might a PICC placement be needed?

In general, PICC is an option for patients who need prolonged treatment (usually more than 14 days) with intravenous fluids, drugs and total parental nutrition and who don’t need a large catheter for this purpose. Your child may receive a PICC to:

• minimize his discomfort from frequent IV catheter changes
• receive strong medications or concentrated IV nutrition without damaging his blood vessels
• continue therapy after leaving the hospital, as you can be trained to give your child’s IV therapy at home

How should I prepare my child for a PICC placement?

Explain to your child in simple terms why the procedure is needed and what will happen.

• Assure your child that you will be close by during the procedure.
• Your child may bring a favorite toy or blanket into the room.

What should I expect when I bring my child to the hospital for a PICC placement?

Your child may receive general anesthesia, sedation, or a local anesthetic at the access site.

• You will be given instructions in advance of the procedure.
• Some children may need an appointment in the pre-op clinic.
• You will meet with the pre-op nurse and an anesthesiologist.
• If you child is having sedation a nurse will call you with instructions when to stop eating and drinking.
• If your child is having a local anesthetic the scheduling office will tell where and when to repost for the procedure.

Your child’s interventional radiologist will explain the procedure to you and your child. Before the procedure begins, you must sign a consent form. You must be your child’s legal guardian to sign this form. If you are a legal guardian and not a parent, you must bring legal paperwork with you showing proof of legal guardianship.

What happens during a PICC placement?

• The interventional radiologist locates your child’s vein to be catheterized either by using an ultrasound probe or by injecting contrast medium into a vein in your child’s hand. Because the vein above the elbow cannot be felt through the skin, image guidance is necessary to minimize the number of needle passes and to avoid placing the needle into the artery or another structure.
• The skin over the area to be catheterized is cleaned with an iodine solution and drapes are placed over the arm and body to prevent infection.
• A small injection of local anesthetic (numbing medicine) will be made where the needle is to be placed.
• A needle is then passed through the skin into the vein.
• Once the needle enters the vein, a guide wire is passed through the needle. This wire is used to guide the soft catheter further into the vein.
• Once the tip of the catheter is placed in the desirable location, it will be secured to the skin with a bandage. The use of the x-ray monitor permits the interventional radiologist to make sure that the tip of the catheter is placed in the best possible location before securing it.

What happens after the PICC placement?

• If the PICC has been placed under sedation, a nurse will take your child to the Interventional Radiology Post-Anesthesia Care Unit (PACU). You will be allowed to come to the recovery area.
• The nurse will monitor your child closely until he is admitted or returned to his hospital bed.
• Some children may be discharged the same day if your doctor has made arrangements for post-procedure teaching, medication delivery, and/or IR therapy nurses.
• The interventional radiologist will speak with you about the procedure.

Is a PICC placement safe?

PICC placement, when performed by a trained and experienced interventional radiologist, is a safe procedure which can usually be performed while your child is under local anesthesia or sedation. As with all invasive procedures, complications and side effects may occur. These will be explained to you in detail before you give your consent.

Your child will be exposed to ionizing radiation (x-rays) during the procedure. We believe that the benefit to your child’s health outweighs the exposure that occurs during the PICC placement. Because children are more sensitive to radiation exposure than adults, we have been leaders in adjusting equipment and procedures to deliver the lowest possible dose to young patients.

How do I learn the results of the PICC placement?

The interventional radiologist will inform you of the results immediately after the procedure. If you have any questions, please speak to your child’s doctor.