The PICC Post

For my HG Sisters

First, let me say, I am sorry you are here.

Second, thank you for doing everything you can for your baby.

Third, you are strong, you are loved, and space is being held for you.  

Lastly, I will explain why I have this insight in a separate post.

Pre- PICC Placement:

• Take a loooooooooooong shower.
• Talk to your physician: Insist on right arm placement.
• The right arm has a more direct route and is far less likely to experience complications, regardless of hand dominance.[i] Let your provider know you are happy to provide evidence-based research for your request. (Here is an article from The Journal ofVascular Access. Let me know if you need more.)

• Insist on a double-lumen full PICC (NO MIDLINE!) so you have the option to do a pump with infusions while also running fluids/vitamins/TPN. Let your provider know you are willing to provide evidence-based research for your request.[ii]
• There are multitudinous supportive published studies like this one (which found “A total of 206 PICCs and 200 MCs [midlines] were inserted in 367 patients within the study duration. Patients with MCs were more likely to have complications than those with PICCs (19.5% vs 5.8%”).[iii]

• Insist on a pump (electronic flow-control infusion devices) for both infusions and hydration so you can titrate over a period of hours rather than gravity infuse. They also make a backpack that can house it if you need to not be attached to an IV pole.
• It is better for your body and for your PICC. (“Infusion pumps offer increased control and accuracy of fluid flow and the ability to detect or prevent other serious errors (e.g., occlusions, air in tubing, free flow).”[iv]^, [v]
• Request 1L/8 hours infusion (most easily done while you are sleeping). It helps reduce infiltration by keeping the pressure into your vein lower. It helps keep the line patent (particularly since Lactated Ringers Dextrose is sticky stuff). An infusion over 8 hours is far less likely to get a fibrin sheath, kink, or occlusion (block), because it has a constant drip keeping clotting away. It more accurately represents continuous hydration and helps your body to maintain rather than get into the dehydration/rehydration loop.

When you arrive:

• Verify right arm, double-lumen, full PICC– you are willing to wait for them to verify with your referring physician. Don’t get on the bed until this is absolutely clarified.
• Ask them to use an ultrasound to place it. Trust me.
• They will need to lay you down flat to begin with. Ask them to put the bed flat first and then let you crawl into it so you don’t have to have the bed move you.
• Crawl in and slowly roll flat. Don’t feel pressured to move quickly.
• They will set up a sterile sheet and prep your arm. Breathe slowly and continuously.
• Ask them to give you a mask/move the sterile sheet high enough that you can be facing the arm.
• *When it is time for line placement, close your eyes and turn your head toward the arm they are putting the line in as they are threading.* This opens the outlet and makes the line less likely to travel the wrong way (don’t worry, it’s not harmful, just annoying).
• Let them know if you feel like something is poking you in the armpit or neck. It doesn’t hurt, but when it’s going the right direction you won’t feel like you’re being poked.
• Breathe slowly and calmly as they place it.

• Ask for two led aprons over the baby when they do the X-ray to check placement.

Post-PICC Placement:

• The PICC arm will be sore for a couple of days, but it doesn’t hurt going in.
• It will feel like weird heartburn in your collarbone/chest, but this feeling will go away. Threading a PICC is a bit invasive for delicate little veins and the can bruise inside, which will translate as pain and pressure.
• If you would like to put a cool or warm compress on your arm to help with soreness:
• DO NOT put it over the part of your arm that has the catheter in it. Catheters can collapse from being temperature shocked.
• Always have fabric in between you and the compress.
• Always use dry heat or cool.
• I 100% recommend babying the heck out of it.
• Don’t overuse it. Seriously.
• Wear a long rubber glove with waterproof medical tape on it when you bathe.
• Sleep on your other side (I know. I’m sorry.).
• Use a stepstool for older siblings when you would normally lift them (to high chair, potty, crib, etc.)
• Flush that bad boy like it’s your job.

Once you're home, visit the PICC Life post to get some ideas on making life easier.

I love you and am thinking of you. Stay strong. This will end.

Much love,

Jeni

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[i] Paquet, F., Boucher, L., Valenti, D., & Lindsay, R. (2018). Impact of Arm Selection on the Incidence of PICC Complications: Results of a Randomized Controlled Trial. The Journal Of Vascular Access, 18(5), 408-414. http://dx.doi.org/10.5301/jva.5000738

[ii] Caprara, J. (2017). Picc Versus Midline. Insights.ovid.com. Retrieved 18 April 2018, from https://insights.ovid.com/pubmed?pmid=29095342

[iii] Xu, T., Kingsley, L., DiNucci, S., Messer, G., Jeong, J., & Morgan, B. et al. (2016). Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center. American Journal Of Infection Control, 44(12), 1458-1461. http://dx.doi.org/10.1016/j.ajic.2016.09.010

[iv] Pinkney, S., Fan, M., Chan, K., Koczmara, C., Colvin, C., Sasangohar, F., … Trbovich, P. (2014). Multiple Intravenous Infusions Phase 2b: Laboratory Study. Ontario Health Technology Assessment Series, 14(5), 1–163. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549602/

[v] Macklin, D. (2011). Infusion Pump Therapy: A Guide for Clinicians and Educators. Lake Forest, IL: Hospira, Inc. Retrieved from https://www.hospira.com/en/images/P11_3241_Infusion_Pump_Therapy_Pocket_Guide_FINAL_tcm81-90336.pdf