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This page tells you about having a PICC (Peripherally Inserted Central Catheter) line insertion. It explains what is involved and what the possible risks are. It is not meant to replace an informed discussion between you and your doctor but can act as a starting point or reminder for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Your procedure will take place in the Radiology department. The radiology department may also be called the ‘X-ray’ or ‘Imaging’ department. It is the facility in the hospital where radiological examinations are carried out, using a range of x-ray equipment, such as a CT (computed tomography) scanner, an ultrasound machine and an MRI (magnetic resonance imaging) scanner.
The team undertaking your procedure will include an Interventional Consultant Radiologist who performs the procedure and they are doctors specially trained to carry out imaging guided complex procedures. They are supported by specialist nurses who are highly trained in interventional procedures, sedation, recovery and patient support alongside support from radiographers who are highly trained to carry out x-rays and other imaging procedures. There is a possibility that there will be various students and trainees involved as this is a teaching hospital.
A PICC is a long, flexible tube that is put into a vein in your arm and threaded up to a large straight vein in your chest. It is similar to a cannula used when you have a drip in your arm. The difference between a PICC and a cannula is that a PICC can stay in much longer – up to several months. A PICC allows your doctor or nurse to give fluids, chemotherapy or medicine into your bloodstream without having to find a vein each time. It can also be used for taking blood samples.
PICCs are used in many different situations. Some patients may need a PICC to avoid having needles put into their arms every time they need treatment or a blood test. Others need a PICC because of the type of treatment they are having, or to help reduce the amount of time they spend in hospital. If you are unsure why you are being offered a PICC, please speak to the team looking after you.
Infection
It is possible for an infection to develop in the skin around the PICC or in the bloodstream. Contact your nursing or medical team, or one of the central venous access nurses, as soon as you can if you experience any of the following symptoms:
- high temperature (over 38°C)
- feeling shivery
- redness or discharge where the PICC was inserted.
If you have an infection, you will need to take a course of antibiotics and your PICC may need to be removed.
Blood clot
It is possible for a blood clot (thrombosis) to form in the vein used for the PICC. This happens in about six out of 100 patients who have a PICC and are also receiving chemotherapy. To help to prevent a clot, try to use your arm normally and drink plenty of fluids while your PICC is in place. If you notice swelling or pain in the shoulder, neck or arm on the same side as the PICC, contact your nursing or medical team, or one of the central venous access nurses, as soon as possible. If you have a clot, you will need medication to dissolve it. The PICC can often stay in place. There is also a small risk of a blood clot on the lungs. This is very rare. If you experience chest pain or sudden shortness of breath, go to your local Emergency Department (A&E) or call an ambulance.
Heart palpitations
PICCs can sometimes cause heart palpitations which feel like a fluttering in the chest or a pounding heart. Palpitations are unlikely to cause you any harm but might mean that the PICC is too far in. If you have palpitations, let us know and we can pull the line out by a centimetre or two. This is a simple and painless procedure.
PICC displacement
There is a small risk that the PICC can be accidentally pulled out. Every time your PICC is used, its external part should be measured to check this has not happened. It is also possible for the PICC to move out of place inside your body. This is not painful but it might stop the PICC from working. If it does happen, the PICC will need to be replaced.
Blockage
PICCs can sometimes become blocked. We can usually unblock them by using a special flushing solution. Occasionally if this fails, the PICC will need to be removed.
Breakage
On rare occasions the PICC may develop a leak. If this happens, the PICC will have to be removed.
Damage to nerves and arteries
It is possible for the nerves or arteries in your arm to become damaged. This is extremely rare but if it did happen it could cause long-term pain or numbness in your hand or arm, which may need surgical repair.
Radiation risk
During the procedure, you are exposed to X-rays. They are a type of radiation called ionising radiation. Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The dose (amount) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation.
The Interventional radiologist and radiographer make sure that:
- Your radiation dose is kept as low as possible.
- The benefits of having X-rays during your procedure are greater than the radiation risks.
This will depend on the type of treatment you are having. You should discuss your options with your doctor or nurse if you have any concerns.
An alternative would be a tunnelled line (sometimes called a Hickman line) or an implantable port. Your doctor or nurse may have suggested a PICC for you but if you would like more information about these alternatives, please talk to the team looking after you.
You will need to have a blood test to measure your full blood count (FBC) and clotting before the procedure. Your doctor or nurse specialist will tell you how to book your blood test when they recommend the line.
You should inform the imaging department prior to your appointment if you are taking any blood thinning medication.
If you have ever had an infection called MRSA (methicillin-resistant staphylococcus aureus), please let your doctor or nurse know. You may need to have a nose swab to see if the infection is still present before your PICC can be put in.
You need to attend the Imaging Department at the time instructed on your appointment letter. You may be asked not to eat for six hours before your appointment time, though you can continue to drink clear fluids up to two hours prior to your appointment. Please take all your medication on the morning of the procedure unless you have been informed to omit it by your doctor or the Imaging department.
On arrival you will be checked into the department by a nurse. The nurse will fill in some paperwork and do some clinical observations-like blood pressure and pulse. The Radiologist will come and explain the procedure and sign off the Consent form with you. This is where you have the opportunity to talk to the Radiologist doing your procedure and they will be able to address any concerns you may have.
This procedure is commonly performed under local anaesthetic, however if you are expecting sedation, it is necessary that you have an escort to take you home and stay with you overnight. This is the policy for sedation, so if you are expecting sedation please ensure you make the necessary arrangements. If you are having sedation during the procedure, the nurse or radiographer will place a cannula into your vein prior to the procedure.
If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney x-rays and CT scans), then you must also tell your doctor about this.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with procedure, by law we must ask for your consent and will ask you to sign a Consent form. This confirms that you agree to have the procedure and understand what it involves.
The consent form is a form that both you and the operating doctor sign confirming that you have discussed the procedure and been informed of the risks/benefits/alternatives and have agreed to carry on with the interventional procedure. (You can have a copy of this form to take with you.)
Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You will lie on the X-ray table, generally flat on your back. You may have monitoring devices attached to your chest and finger throughout the procedure.
The procedure is performed under sterile conditions and the interventional radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion, will be swabbed with antiseptic and you will be covered with sterile drapes.
The radiologist will use an ultrasound machine to locate a vein in your arm and decide where best to place the PICC line. They will inject local anaesthetic into the skin to numb it. This will cause some temporary discomfort but once the skin is numb you won’t feel the PICC being threaded up through your vein. You should not feel any pain but just a small amount of pressure. Please let the nurse know if you are uncomfortable.
We will check the position of the PICC line with the X-ray machine. Once the PICC is in, the radiologist will insert a tiny anchoring device and a special dressing to keep the line in place. Occasionally there are difficulties in accessing a vein or threading the PICC into position. If this happens, the radiologist will probably try again using a different vein.
Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic. After this, the procedure should not be painful. There will be a nurse, or another member of clinical staff, standing nearby looking after you. If the procedure does become uncomfortable please inform the nurse looking after you.
Your PICC will be secured to your arm using either a SecurAcath®, or, a Statlock®. A SecurAcath® is designed to secure the PICC for the entire duration of the therapy and does not need to be changed. It should be cleaned at the exit site every seven days, at the same time as the dressing change.
Fig 2. Image showing a SecurAcath®
It will be removed when the PICC is removed. You can have an MRI with the SecurAcath® in place.
Fig 3. Image showing a Statlock®
A Statlock® needs to be changed every seven days, at the same time as the dressing change.
Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will be over in about 45 minutes.
If needed, the line can be used straight after it has been put in.
You may be taken to the recovery area on a trolley. A recovery nurse may need to carry out routine observations, such as taking your pulse and blood pressure. They will also look at the skin entry point to make sure there is no bleeding from it. You should be able to go home or back to the ward dependent on if you are an outpatient or inpatient.
You will be able to use your arm normally while the PICC is in but it is important that you keep the dressing dry. We will give you a special plastic sleeve to put on when you have a shower or a bath. Swimming is not recommended. Both the dressing over the PICC will need to be changed and the PICC flushed weekly. Flushing is a painless procedure where a syringe is attached to the PICC and fluid is flushed into it to stop it from getting blocked.
If you are going home with your PICC in, the chemotherapy or ward nurses may refer you to the district nurses for your PICC care. Alternatively, if you prefer to have it done at UCLH, you will need to make an appointment in the Supportive Care Unit on the fourth floor of the Macmillan Cancer Centre. Some patients prefer their partner, a family member or a close friend to care for their PICC. If this is something you would like, please discuss it with one of the central venous access nurses or your referring team.
While your PICC is in place, it is important that you contact your nursing or medical team, or one of the central venous access nurses, if you notice any of the following:
- a high temperature (over 38°C)
- feeling shivery
- a sore or swollen arm
- unusual heartbeat
- your PICC becoming displaced.
A PICC can stay in for several weeks or months and it will be removed by one of the nurses on the ward or in day care when you no longer need it. Removal of the PICC itself does not hurt but some patients experience discomfort when the anchoring device is taken out. If this happens, ask the nurse to give you an injection of local anaesthetic to numb the skin.
Some of your questions should have been answered on this page but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact and references
British Society of Interventional Radiology
Macmillan Cancer Information
For general information about radiology departments, visit The Royal College of Radiologists
NHS Direct
For health advice or information you can call NHS Direct on 0845 45647 or visit the website: www.
The NHS Clinical Knowledge Summaries website: www.
UCL Hospitals cannot accept responsibility for information provided by other organisations.
Please contact the Clinical Nurse Specialist (CNS)
Direct line: Interventional radiology CNS: 0797 487 5629
UCH Switchboard: 020 3456 7890
Address:
Interventional Radiology Imaging Department
University College Hospital
2nd Floor
235 Euston Road
London
NW1 2BU
Admin Queries Email: uclh.
Radiology Admin enquiries phoneline: 020 3447 3267
Website: www.
If you have been referred by the Central venous access team, please contact:
(Monday to Friday, 9am to 5pm)
Telephone: 020 3447 7491
Supportive Care Unit
(Monday to Friday, 8am to 8pm)
Telephone: 020 3447 1808
Out of hours Oncology patients: 07947 959 020
Haematology patients: 07852 220 900
Teenagers and young adults: 07908 468 555
If you are not under any oncology team, please contact our interventional clinical nurse specialist.
Procedures:
The Imaging Department, Level 2 Podium in the main University College Hospital building with the entrance on Euston Road (see map below).
Travelling to the hospital
No car parking is available at the hospital. Street parking is limited and restricted to a maximum of two hours.
Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone.
Tube
The nearest tube stations, which are within two minutes’ walk are:
- Warren Street (Northern and Victoria lines)
- Euston Square (Hammersmith & City, Circle and Metropolitan lines)
Overground trains
Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within 10-15 minutes’ walk.
Bus
Further travel information can be obtained from http://
Hospital transport service
If you need (and are eligible for) transport, please call:
020 3456 7010 (Mon to Fri 8am-8pm) to speak to a member of the Transport Assessment Booking Team.
If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please 020 7380 9757 to cancel your transport.
University College Hospital Area Map
Page last updated: 31 July 2024
Review due: 01 July 2026