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Caring for a Peripherally Inserted Central Catheter or Midline Catheter
WHAT YOU SHOULD KNOW:
- Peripherally inserted central catheters are also called PICC lines or central venous catheters (CVC). A PICC line is a small, flexible catheter (tube) that is put into a vein. Veins are blood vessels that carry blood to your heart from the rest of your body. PICC lines are placed into a vein in your arm, and then guided into a larger vein in your chest. A midline catheter is put into a vein by the bend in your elbow or your upper arm. The midline catheter tube is shorter than a PICC line. The midline tube ends in a vein below your armpit. Having a PICC or midline catheter may allow you to receive long-term intravenous (IV) medicine or treatments.
- PICC lines and midlines can stay in place longer than some other types of IV catheters. PICCs and midlines are used for IV therapy given for more than five days at a time. Having a PICC or midline may decrease the number of needle sticks that you need to get medicine, or have blood samples collected. PICC and midline catheters have one or more lumens. A lumen is a tube outside of your body with a cap, hub, or port on the end. By having more than one lumen, you may be able to get more than one medicine or treatment at a time.
AFTER YOU LEAVE:
- Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take. Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists.
- Nonsteroidal anti-inflammatory medicine: Ask your caregiver if you should use anti-inflammatory medicine (NSAIDs). This medicine may help decrease pain and redness at the place where the catheter enters your skin. You can buy it with or without a prescription. NSAIDs can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
- Blood thinners: Blood thinners are medicines that help prevent blood clots from forming. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. If you are taking a blood thinner:
- Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin and a soft toothbrush on your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports, such as football.
- Be aware of what medicines you take. Many medicines cannot be used when taking medicine to thin your blood. Tell your dentist and other caregivers that you take blood-thinning medicine. Wear or carry medical alert information that says you are taking this medicine.
- Take this medicine exactly as your caregiver tells you. Tell your caregiver right away if you forget to take the medicine, or if you take too much. You may need to have regular blood tests while on this medicine. Your caregiver uses these tests to decide how much medicine is right for you.
- Talk to your caregiver about your diet. This medicine works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and other foods, such as cooked peas and kiwifruit.
- Saline: A solution called saline may be used to flush your catheter. This liquid may help keep the catheter open and clear.
- Heparin: A solution called heparin may be used to flush your catheter. Heparin is medicine that helps prevent blood clots from forming inside the catheter. If heparin is used to flush the catheter, problems including allergic reaction, bleeding, and heparin-induced thrombocytopenia (HIT) can develop. HIT is a low number of blood platelets, which increases the risk of bleeding. Ask your caregiver to talk to you about these risks.
- Home IV medicines: Ask caregivers for information about the medicines and treatments that you need to take at home. Medicine may be brought to your home. Read the label, and ask caregivers for any special directions for storing your medicines. You may need to keep your medicines in the refrigerator.
- TPN: TPN stands for total parenteral nutrition. It is also called hyperalimentation. It provides your body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat (lipids). TPN is used when you have problems with eating or digesting food. TPN is usually put into your body through a large IV catheter, such as a central line. You may need TPN for several days or longer.
Using a medicine pump:
You may use a pump to get medicine through the PICC or midline catheter. You may be taught to prepare and attach your medicine to the pump. Ask caregivers how to use and care for your pump, and what to do when the alarm sounds.
Ask for information about where and when to go for follow-up visits:
For continuing care, treatments, or home services, ask for more information.
Always wash your hands with soap and water before touching the catheter or the area around it. Washing your hands will help prevent infection. Ask caregivers for information about hand hygiene. Do not touch or handle your catheter unless you need to use it or care for it. Wash your hands and put on new medical gloves before touching or handling your catheter.
Use warm compresses:
The area where the PICC or midline was inserted may feel sore. Use a warm compress to decrease pain and swelling in your arm. You can make a warm compress by wetting a small towel with hot water. Wring out the extra water, wrap the towel in plastic, and put it on the area. Use the compress four times a day, for 10 minutes each time. You may want to do this for three days after the catheter is placed. Prop your arm up on pillows when you are sitting or lying down to decrease swelling.
- Do not go swimming, as this exposes your PICC or midline catheter to germs that can cause infection.
- Do not lift heavy items or do very hard exercise, such as shovelling.
- Do not use sharp objects near the catheter to avoid cutting or damaging it. Do not use scissors when changing the bandages over your PICC or midline catheter.
- Remind caregivers not to check your blood pressure or give needles in the arm where the catheter is placed.
- Your caregiver may tell you to take showers rather than baths to help prevent infection. When showering or bathing, keep the area where the catheter was inserted covered and sealed with plastic wrap. This will keep the area of skin and the bandage dry, and help prevent an infection.
Caring for the PICC or midline catheter:
- Clean the end of the catheter tubing before using the catheter: Before attaching, and after detaching tubing from your catheter, the ends of the tubing (caps, hubs and injection ports) must be cleaned. Cleaning the end of the tubing removes the germs that can cause an infection. A new alcohol pad may be used to clean the end of the tubing. Wash your hands, and open the package with the new alcohol pad. Put on new medical gloves. Rub the alcohol pad briskly on the cap, hub, or port, and throw the alcohol pad away. Ask your caregiver to show you how to clean the end of the catheter tubing.
- Clamping the catheter: You may need to clamp your catheter at certain times, such as when the tubing is being changed. The catheter is clamped to help prevent air from getting in. Ask caregivers if you need to clamp your PICC or midline catheter. Ask them when and how this is done.
- Changing the caps and tubing: The caps on the catheter lumens must be changed regularly. The tubing used to give medicine or liquids also must be changed. Ask your caregiver how often these tasks need to be done, and who should do them.
- Loop extra tubing: If you have long tubing attached to your catheter, loosely loop the tubing together, and secure it with tape. This will help prevent the PICC or midline catheter from being pulled out of your arm by accident.
When to change the bandage on the PICC or midline catheter:
Caregivers may change the bandage the day after your PICC or midline catheter is put in. After the first bandage change, ask caregivers when, and how often, to change the bandage. If there are no signs of infection where the catheter enters your skin, weekly bandage changes may be done. The bandage should also be changed if it gets moist, wet, loose, or dirty. Change the bandage if it has moved out of place, and no longer covers or sticks to the point where the catheter enters your skin.
How to check and clean the area around the catheter and change the bandage:
Check your skin where the catheter enters it every day. Look for signs of infection and other problems. Clean your skin before every bandage change.
- Prepare your work area and supplies: Prepare an area for the supplies needed to clean your skin and change your bandage. The area should be away from open windows, heating ducts, and fans. Be sure it is well-lit, clean, and free of dust. Prepare a place to sit or lie down while you work with your catheter. Supplies to take care of your PICC or midline catheter may be sent to your home. Keep them away from children and pets. Your caregiver will teach you how to order more supplies when you need them. You may need the following supplies:
- Liquid soap in a pump, or a bottle of waterless soap. This is used to wash your hands.
- Paper towels. These are used to dry your hands.
- A trash bag.
- Solution to clean your skin. Ask your caregiver what solution to use. You may need small packages of gauze to apply the solution.
- New gauze bandages and medical tape, or clear adhesive (sticky) bandages. Ask your caregiver which type of bandage to use. If you use a gauze bandage and tape, get four strips of tape ready to secure your bandage. (Tape is not used for clear adhesive bandages.) Open the package with the new bandage, and leave the bandage in it until you are ready to use it.
- Sterile (germ-free) or clean medical gloves. You may also need to wear a medical mask. Ask your caregiver if you need to wear a mask.
- Wash your hands and put on gloves: Put on the mask if you need to wear it. Gently press on the area where the catheter enters your skin. If you feel pain or discomfort, call your caregiver.
- Gently remove the old bandage and throw it into the trash bag: Throw your gloves into the trash bag, and put on new gloves.
- Look at the place where the catheter goes into your arm: Look for skin redness, swelling, blood, or fluid. Call your caregiver if you see any of these signs.
- Clean the area around your catheter: Prepare to clean your skin with the solution your caregiver suggests. Ask caregivers how to clean your skin. Avoid pulling, pushing on, or moving the catheter. You may clean your skin using a scrubbing back-and-forth movement. You may also start where the catheter enters your skin, and clean outward from it in circles. The circles should get larger as you clean away from the catheter. Throw the swab or gauze used to clean your skin into the trash bag. Let the clean area of skin dry for a few minutes.
- Put on the clean bandage: If you use a gauze bandage, place the bandage over the area where the catheter enters your skin. Secure the tape around all edges of the gauze bandage to hold it firmly against your skin. If you use a clear adhesive bandage, remove the backing and carefully place it over the area. Gently smooth the clear adhesive bandage over the area to remove any wrinkles. Remove your gloves and mask and throw them away in the trash bag. Wash your hands.
When and how often to flush the catheter:
Your PICC or midline catheter may need to be flushed. This is when you push a small amount of medicine or liquid through your PICC or midline catheter using a syringe. Flushing is done to help prevent your catheter from getting blocked. Flushing is also done to help prevent medicines from mixing with each other in the tubing. Ask caregivers when to flush your PICC or midline catheter. You may need to flush the catheter:
- Before giving yourself a medicine or treatment.
- After giving yourself a medicine or treatment.
- Once a day, if you use the PICC or midline catheter often.
- Once a week, if you do not use the PICC or midline catheter often.
How to flush the PICC or midline catheter:
Ask your caregiver how to flush your catheter. You may need to do the following:
- Wash your hands. Put on medical gloves.
- Clean the end of the catheter tubing as your caregiver has shown you.
- Push or screw the syringe with the flushing solution into the end of the catheter tubing.
- Using the syringe plunger, slowly push the fluid out of the syringe and into the catheter. If it feels hard to push in the plunger, do not force it. Forcing the plunger could damage the catheter, or cause serious harm. Look for kinks in the tubing that may be pinching off the catheter. Straighten any kinks in the tubing. If you do not find a kink, this may mean that your catheter is blocked. Call your caregiver.
- After the solution is pushed into the catheter, pull or unscrew the syringe. Dispose of the syringe as your caregiver has told you to, and clean the catheter end. Throw away your gloves, and wash your hands.
CONTACT A CAREGIVER IF:
- You have a fever.
- You feel pain in your arm, neck, shoulder, or chest on the side that your catheter is in.
- The veins in your neck or chest are easier to see, or look larger than usual.
- Your arm, neck, or face is swollen and red on the side that your catheter is in.
- It is hard to push the plunger of the syringe in when giving medicine or flushing your catheter. You may see that liquids are flowing into the catheter more slowly. Check for kinks in the tubing. Straighten out any kinks that you find. If liquid keeps flowing in slower than it should, call your caregiver.
- You see air in the tubing.
- You feel pain when liquid is going into your PICC or midline catheter.
- You see that the catheter is getting shorter or longer.
- There is new or more blood on your bandage.
- Your bandage gets wet, loose, dirty, or falls off, and you do not know how to change it.
- You run out of supplies to care for your catheter.
SEEK CARE IMMEDIATELY IF:
- The area around where the catheter enters your skin looks red, feels warm or painful, or it is oozing fluid.
- You see a red line going up your arm from the place where the catheter enters your skin. Your arm will also be painful.
- You see blisters around the place where the catheter enters your skin.
- Your PICC line or midline is cracked or has a hole in it. If you see a crack or hole, clamp your catheter above it and see your caregiver immediately.
- Your PICC or midline catheter falls out, or is pulled out by accident.
- Your arm or leg feels warm, tender, and painful. It may look swollen and red.
- You have chest pain or trouble breathing that is getting worse over time.
- You suddenly feel lightheaded and have trouble breathing.
- You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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