Remove a PICC Line

A PICC (peripherally inserted central catheter) is a type of catheter, normally inserted in the forearm. A PICC line is a safe, stable way to deliver intra-venous (IV) medications. It can stay in the body for weeks or months, alleviating the need to subject your veins to the numerous needle sticks necessary if the PICC was not there.

Following medical treatment, a patient's physician will decide when it is safe to remove the PICC line. -- Patients should use this article for information purposes only. Some information -- in steps, tips and warnings -- is included on flushing the line and preventing clots.

Steps

Removing the Catheter

1. Be aware that only doctors or registered nurses remove a PICC. Otherwise, serious complications or infections could arise.
   • Only proceed with these steps if you are a registered doctor or nurse who is qualified to take care of the patient.
2. Wash your hands. Before you begin the procedure or touch any of the materials required for the removal of the PICC line, wash your hands thoroughly with antibacterial soap and put on a new pair of sterile gloves. This reduces the chances of the patient developing an infection.
3. Prepare the materials for removing the catheter. Place all the materials that will be used throughout the procedure, so you will have them easily at hand.
   • These materials will include a pair of sterile scissors, some air-occlusive dressing, a stitch cutter, sterile dressing packages and cotton balls soaked in betadine solution..
   • Systematically arrange all of these materials near the patient’s bed before the procedure, so they are orderly and easy to reach.
4. Explain the process of removing the PICC line to the patient. This is to establish trust and cooperation by the patient. Be ready to reply to any possible questions about the procedure that the patient may ask.
5. Get the patient into the correct position. Before you begin the procedure, ask the patient to get into the correct position. The patient should be lying flat on his or her back, facing upwards, with all four limbs in contact with the bed. This is known as a supine position.
   • Make sure the patient has a clean bed, with fresh sheets. This helps to make the patient more comfortable and avoid infection.
6. Clean the skin around the catheter. Get a cotton ball soaked in betadine solution and clean the area around the PICC line, moving from the skin nearest the catheter outwards.
   • This is an important step, as it cleans any bacteria from the surface of the skin, reducing the chance of infection.
   • Once you've cleaned the skin, turn off the infusion set and prepare the dressing patch so it is ready to apply immediately following the procedure.
7. Remove the catheter. Using a stitch cutter, carefully cut and remove the suture that holds the PICC line in place. Ask the patient to hold his or her breath, then, using your dominant hand, slowly pull the catheter out in the opposite direction of insertion. Do not apply any direct pressure on the insertions site.
   • Upon removal of the catheter, immediately cover the insertion site with sterile gauze and hold it in place using light pressure.
   • Ask the patient to continue holding their breath while you cover the area with an occlusive dressing. Once this is done, allow the patient to breathe normally and return to a comfortable position.
8. Monitor the patient's condition for 24 to 48 hours. After the removal of the PICC line, monitor the patient’s condition for 24 to 48 hours. Observe the patient for any signs of infection, such as fever. Also, observe the site for bleeding and assess the patient for any difficulty of breathing.
   • The dressing should remain in place for 24-72 hours, depending on the length of time the catheter was used for.

Helping the Recovery Process

1. Inform the patient about several complications that can arise from a PICC removal. It is important that the patient is made aware of these complications before the procedure takes place. Possible complications include:
   • Breakage of the PICC line. This is serious complication of PICC line removal. To prevent breakage, the line should be removed gently land slowly without exerting much force.
   • Infection. This is another potentially serious complication that a patient with PICC line can experience. An infection can arise at any time. Therefore, it is beneficial for the medical team to regularly monitor the PICC line, clean and train you to maintain its sterility as much as possible. The line would be flushed after each use and between changes of medication using a syringe of normal saline.
   • Blood clot." While the PICC line is in place for weeks or months it is a good practice to infuse enough heparin (an anticoagulant) to fill the line thus preventing the line or tip from forming small blood clots between uses, in the idle time until the next infusion. This is done immediately after flushing the line with a syringe of normal saline solution.
   • Embolism caused by catheter fracture. This is a serious complication of PICC line removal that can cause the patient to lose consciousness if a blood clot reaches the brain.
   • Swelling and redness. These inflammatory symptoms can also occur as a complication of PICC line. The swelling and redness usually develop near the insertion of the catheter site.
2. Advise the patient on the proper dosages for pain medications. After removal of the catheter, the patient may experience pain in the upper arm. As a result, the patient's physician may prescribe pain medications or recommend over-the-counter medications so the patient can go about their daily activities.
   • One of the most common OTC pain medications recommended following PICC line removal is ibuprofen. Ibuprofen is a non-steroidal anti-inflammatory medication that has both antipyretic (reduce fever) and and analgesic (reduce pain) properties.
   • The recommended dose of ibuprofen (according the the Centers for Disease Control) is 200-400mg, taken orally every 4 to 6 hours. It is recommended that ibuprofen should be taken with some food or milk to avoid stomach problems
3. Inform the patient about what sort of exercises to avoid. Be sure to inform the patient to not engage in any strenuous exercises or do any heavy lifting for a minimum of 24 hours following PICC line removal. This includes moving furniture, lifting heavy boxes or engaging in any activity that involves repetitive arm or hand movements.
4. Educate the patient on proper nutrition. A healthy diet is essential for proper healing, therefore it's a good idea to educate the patient about the types of food to eat following the procedure.
   • This includes eating a lot of iron-rich foods to increase blood supply and strengthen the body. Iron-rich foods include red meat, chicken, spinach, broccoli, shellfish, pumpkin and sesame seeds, and nuts like peanuts, pecans, pistachios and almonds.
   • If you/the patient has lost weight, you are encouraged to eat calorie-rich smoothies and shakes, which are full of nutrients, vitamins and natural sugars that will help one to gain weight in a healthy way.
   • Instead of eating three large meals a day, the patient should be encouraged to eat smaller meals more frequently throughout the day. This will help to keep their energy levels up.

Tips

• If an infection is suspected, obtain a doctor’s order to allow the tip of the catheter to be brought to the laboratory for culture.
• The reported rates of PICC line infections are low if proper maintenance protocols are followed. Your care team of skilled nurses teach and train patients the basics of sterile technique and how to properly care for the line:
  • The lines need to be flushed at regular intervals, and the dressing over the insertion point of the catheter needs to be changed weekly by your team.
• Using a Heparin flush after the saline flush prevents a complicating clot formation within the catheter's tip or lumen: A clot (or thrombosis) also provides a dangerous medium, or "nidus," in which bacteria, virus or fungus can grow. Remember SASH for the flushing sequence:
  • S - saline flush
  • A - administer medication
  • S - saline flush
  • H - heparin flush.

Warnings

• Caution: A PICC has, on average, 50 to 65 cm of length in which a clot might still develop, after is flushed but small amounts of blood remain in the line or tip.

Sources and Citations

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