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Peripherally Inserted Central Catheters and Midline Catheters
What you need to know about peripherally inserted central catheters and midline catheters:
A catheter is a small tube used to give treatments and to take blood. A catheter can help protect your veins because medicine goes through the catheter instead of through your veins. The catheter is guided into place through a peripheral vein in your upper arm. Peripheral veins lead from your arms and legs to your heart. A peripherally inserted central catheter (PICC) is guided into a vein near the heart. A midline catheter is inserted into one of 3 veins in your arm. The end of a midline does not go past the top of your armpit.
How to prepare to have a catheter inserted:
- If you are a woman, tell your healthcare provider if you are or think you may be pregnant.
- Tell healthcare providers if you are allergic to latex or have any other allergies. Tell them if you had radiation or surgery on your chest, or any problems with a PICC or midline catheter. Also tell them if you have ever had an allergic reaction to contrast liquid.
- Talk to your healthcare provider about all medicines you take. You may need to stop taking certain medicines a few days before your procedure. Examples include aspirin, NSAIDs, and prescription blood thinners.
- You may need treatment for medical problems, such as an infection or a bleeding condition. Your healthcare provider may use an ultrasound to find your veins. He or she will also make sure the veins are healthy enough for a catheter.
- You may be told not to eat or drink anything for several hours before the procedure. Your healthcare provider will give you specific instructions to follow. The instructions will include medicines to take or not take on the day of your procedure.
- Arrange to have someone drive you home after the procedure.
What will happen during the procedure:
- You will get local anesthesia to numb the area.
- A band will be tightened around your arm. This helps your healthcare provider see your veins. The band also stops blood from flowing into the vein while healthcare providers place the catheter.
- Your healthcare provider will put a needle through your skin and into your vein. Your provider may use an ultrasound or x-ray to place the catheter correctly. Tell the provider if you feel pain or tingling while the catheter is being placed.
- The needle and sheath (covering) will be removed, and the catheter will be left in the vein. Healthcare providers may secure the catheter to your skin with tape or stitches. A new bandage will be placed over the area to keep it clean and to help prevent infection.
What will happen after the procedure:
If you have a PICC, a chest x-ray will be done to show healthcare providers the location of the catheter tip. You may be able to go home after the procedure. Plan to rest when you get home. You should be able to go back to your normal activities the next day. Your healthcare provider will tell you which activities are okay for you. Do not lift heavy objects. You will get instructions on how to care for your incision wound, and when it is okay to shower or bathe. This is usually after about 1 week.
Risks of having a PICC or midline catheter:
- More than one attempt may be needed to place the catheter. The vein where your catheter is placed may become irritated, and your skin may get red, painful, and blister. When the catheter is put in, your vein may tear, or the catheter may injure a nerve. Your catheter may get blocked, and healthcare providers may need to remove or replace it.
- The catheter may break, bend, or move out of place. The IV medicine may leak outside your vein and cause pain, swelling, or blisters. You can have bleeding, an allergy to heparin, or heparin-induced thrombocytopenia (HIT). HIT is a low number of blood platelets. This increases the risk of bleeding. You may get a blood clot in your arm. These problems can be life-threatening.
Seek care immediately if:
- You feel pain in your arm, neck, shoulder, or chest.
- The catheter site turns cold, changes color, or you cannot feel it.
- You cough up blood.
- You see blisters on the skin near the catheter site.
Contact your healthcare provider if:
- You have a fever.
- The catheter site is red, warm, painful, or oozing fluid.
- You see blood on your bandage and the amount is increasing.
- The veins in your neck or chest bulge.
- You cannot flush your catheter, or you feel pain when you flush your catheter.
- You see that the catheter is getting shorter, or it falls out. Put pressure on the site with a clean towel before you contact your healthcare provider.
- You see a hole or a crack in your catheter. Clamp your catheter above the damage before you contact your healthcare provider.
- You have questions or concerns about your catheter.
- NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Apply a warm compress as directed:
The area where the catheter was inserted may feel sore. A warm compress can help to decrease pain and swelling in your arm. Wet a small towel with warm water. Wring out the extra water. Wrap the cloth in plastic, and put it on the area. Use the compress 4 times a day, for 10 minutes each time. Prop your arm up on pillows when you are sitting or lying down. This will decrease swelling.
Prevent catheter-associated infections:
The area around your catheter may get infected, or you may get an infection in your bloodstream. A catheter-associated infection is caused by bacteria getting into your bloodstream through your catheter. Infections from catheters can lead to severe illness. The following are ways you can help prevent an infection:
- Wash your hands often. Use soap or an alcohol-based hand rub to clean your hands. Clean your hands before and after you touch the catheter or the catheter site. Remind anyone who cares for your catheter to wash their hands.
- Wear medical gloves. Wear clean medical gloves when you touch your catheter or change bandages.
- Limit contact with the catheter. Do not touch or handle your catheter unless you need to care for it. Do not pull, push on, or move the catheter when you clean your skin or change the bandage.
- Clean your skin as directed. Clean the skin around your catheter every day and just before you change your bandage. Ask your healthcare provider what to use to clean your skin.
- Check for signs of infection. Check your skin every day for signs of infection, such as pain, redness, swelling, and oozing. Contact your healthcare provider if you see these signs.
- Cover the area. Keep a sterile bandage over the catheter site. Change the bandage as directed or when it is loose, wet, dirty, or falls off. Change your bandage in a place away from open windows, heating ducts, and fans. Be sure it is well-lit, clean, and free of dust. Clean the skin under the bandage with the solution your healthcare provider suggests. Let the area dry before you put on the new bandage.
- Keep the area dry. Do not let your catheter or catheter site get wet. Wrap your arm with plastic and seal it with medical tape before you bathe. Ask if you should take showers instead of baths. Do not swim or soak in a hot tub.
Follow up with your healthcare provider as directed:
Write down your questions so you remember to ask them during your visits.
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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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