PICC Line Care at Home: Step-by-Step Guide for Flushing & Dressing Changes

Quick Overview

A PICC (Peripherally Inserted Central Catheter) is a long, thin IV tube inserted in your upper arm for long-term medication delivery. Proper home care prevents infection and complications. This guide covers flushing, dressing changes, cap changes, and troubleshooting.

What is a PICC Line?

Definition

  • PICC = Peripherally Inserted Central Catheter
  • Small, flexible IV tube (15-24 inches long)
  • Inserted into vein in upper arm
  • Tip rests in large vein near heart (superior vena cava)
  • Can stay in place for weeks to months

Why PICC Lines Are Used

Common indications:
✓ Long-term IV antibiotics (e.g., endocarditis, osteomyelitis)
✓ Chemotherapy administration
✓ Total parenteral nutrition (TPN)
✓ IV fluids and medications
✓ Blood transfusions
✓ Frequent blood draws
Advantages over standard IVs:
  • Longer duration (weeks-months vs. days)
  • Less painful than repeated IV sticks
  • Reduces vein damage
  • More reliable access
  • Can be used at home

PICC Line Anatomy

Key Components

1. Catheter Tube
  • Flexible silicone or polyurethane
  • 15-24 inches long (trimmed to fit)
  • Inserted in upper arm vein
2. Lumens
  • Lumen = opening/path inside catheter
  • PICCs have 1, 2, or 3 lumens
  • Each lumen can deliver different medications simultaneously
3. External Components
  • Catheter cap (needleless connector): Allows syringe attachment
  • Clamp: Controls flow in/out of catheter
  • Extension tubing: Connects catheter to IV bags/syringes
  • Dressing: Covers insertion site

PICC Placement Diagram

Upper arm insertion → Travels through vein → 
Tip rests in superior vena cava (near heart)
Confirmation: Chest X-ray verifies proper tip placement after insertion.

PICC Line Insertion

Procedure Overview

Where: Bedside or radiology department
Duration: 30-60 minutes
Anesthesia: Local anesthetic (numbing medication)
Steps:
  1. Arm cleaned and numbed
  2. Ultrasound guides needle into vein
  3. Catheter threaded through vein toward heart
  4. Catheter secured and dressed
  5. Chest X-ray confirms placement
Post-insertion:
  • Mild soreness normal for 24-48 hours
  • Arm may feel tight or heavy initially
  • Report severe pain, swelling, or bleeding

Essential PICC Care Tasks

Daily/Weekly Care Schedule

Task Frequency
Flush with heparin Daily (if not in use)
Replace alcohol cap After each flush
Change gauze dressing 3x/week (Mon, Wed, Fri)
Change clear dressing Every 7 days
Change catheter cap Every 7 days
Inspect insertion site Daily
Hand hygiene Before every care task

Hand Hygiene: Critical First Step

Why It Matters

  • #1 way to prevent infection
  • Removes invisible germs
  • Required before ALL PICC care

Two Methods

Method 1: Soap and Water (Preferred)
  1. Wet hands and wrists under warm water
  2. Apply soap and scrub vigorously for 15 seconds
  3. Work lather between fingers, under nails, palms, back of hands
  4. Rinse well (hands up, water runs toward elbows)
  5. Dry with clean paper/cloth towel
  6. Turn off faucet with towel
Method 2: Alcohol-Based Hand Sanitizer
  1. Apply dime-size amount to palm
  2. Rub into palms, back of hands, between fingers
  3. Allow to air dry completely
When to use soap:
  • Hands visibly dirty
  • After bathroom use
  • If you have C. difficile infection

Preparing Your Work Area

Selecting Location

✅ Good choices:
  • Kitchen table
  • Clean counter
  • Laminate mat
  • Tray
❌ Avoid:
  • Bathroom (most germs)
  • Cluttered areas
  • Drafty locations
  • Poor lighting

Preparing Surface

  1. Place trash can nearby
  2. Clean surface with household disinfectant or rubbing alcohol
  3. Let air dry completely
  4. Ensure good lighting
  5. Gather all supplies before starting

Supply Storage & Handling

Storage Guidelines

✓ Keep away from children and pets
✓ Store in dry, clean area
✓ Away from dirt, dust, clutter
✓ Close to work area
✓ Check expiration dates regularly

Checking Supplies

Do NOT use syringes if: ❌ Leaks present
❌ Fluid cloudy or discolored
❌ Particles or specks in fluid
❌ Expired
Do NOT use packaging if: ❌ Seal broken
❌ Package torn
❌ Any part wet

Handling Sterile Supplies

Key rules:
  • Sterile = all germs removed
  • Never touch sterile parts with hands
  • Don't let sterile items touch non-sterile surfaces
  • Keep sterile items in packaging until use

Flushing Your PICC Line

Why Flushing is Essential

✓ Prevents blood clots in catheter
✓ Keeps catheter patent (open)
✓ Reduces infection risk
✓ Maintains catheter function

Flushing Schedule

Daily: If PICC not in use
After each use: If medications given
Before and after: Blood draws or medication administration

Supplies Needed

  • Prefilled heparin flush syringe (10 units/mL) - one per lumen
  • Alcohol pads
  • New alcohol cap
  • Trash can

Step-by-Step Flushing Procedure

1. Prepare
  • Clean work surface
  • Wash hands (15 seconds)
  • Gather supplies
2. Clean Catheter Cap
  • Remove old alcohol cap
  • Open alcohol pad
  • Vigorously scrub catheter cap for 15 seconds
  • Let air dry (don't blow or fan)
3. Prepare Syringe
  • Press plunger to break seal (don't pull back)
  • Hold upright and tap sides
  • Push plunger to remove all air bubbles
4. Flush Catheter
  • Push and twist syringe into cap (clockwise until secure)
  • Unclamp catheter
  • Push flush solution slowly until 0.5 mL remains
  • Clamp catheter while removing syringe
  • Discard syringe
5. Attach New Alcohol Cap
  • Twist new alcohol cap onto catheter cap
  • Ensure secure fit
For multi-lumen PICCs: Repeat for each lumen with separate syringe.

Important Flushing Tips

⚠️ Never use force - if resistance, call clinician
⚠️ Hold catheter cap when connecting/disconnecting syringes
⚠️ Never reuse syringes
⚠️ Check cap is secure before flushing
⚠️ Heparin doesn't need refrigeration

Changing the PICC Dressing

Dressing Change Schedule

Dressing Type Change Frequency
Gauze and tape 3x/week (e.g., Mon, Wed, Fri)
Clear/transparent Every 7 days
Wet, dirty, or loose Immediately

Supplies Needed

IV Dressing Change Kit contains:
  • Sterile drape
  • Sterile gloves
  • Skin protectant pad
  • ChloraPrep® (antiseptic)
  • Gauze sponge
  • Mask
Additional supplies:
  • Securement device (Stat Lock)
  • IV dressing
  • Trash can

Step-by-Step Dressing Change

1. Prepare (5 minutes)
  • Clean work surface
  • Wash hands thoroughly
  • Gather supplies
  • Open dressing kit
  • Put on mask
  • Remove sterile drape and place on work surface
  • Place kit contents on sterile drape
2. Remove Old Dressing (2 minutes)
  • Pull dressing corners toward catheter exit site
  • Once loosened, hold catheter down and pull dressing up/off
  • Don't touch insertion site area
  • Discard old dressing
3. Inspect Insertion Site (1 minute)
  • Look for signs of infection:
    • Redness
    • Swelling
    • Tenderness
    • Drainage
    • Warmth
  • If present, finish dressing change then call clinician
4. Clean Hands Again
  • Use instant hand sanitizer
  • Let air dry
5. Clean Insertion Site (3 minutes)
  • Put on sterile gloves
  • Open ChloraPrep® swabstick
  • Clean area using back-and-forth motion for 30 seconds
  • Clean at least 2 inches around exit site
  • Let air dry completely (don't blot or wipe)
  • Repeat with remaining swabsticks
  • Discard each after use
6. Apply Skin Prep (1 minute)
  • Apply to area around catheter (starting 1 inch away)
  • Work outward
  • Let dry until smooth and shiny
  • Wait for complete drying
7. Apply New Dressing (3 minutes)
  • Remove protective backing
  • Center transparent window over exit site
  • Slowly remove frame while smoothing edges
  • Take adhesive strip and "butterfly" around catheter
  • Place second strip over butterfly
8. Apply Securement Device (2 minutes)
  • Peel paper backing from Grip-Lok®
  • Place under catheter on split area of dressing
  • Lift top flap and remove "peel" backing
  • Place catheter tubing on bottom strip
  • Close top flap over tubing to secure
Total time: ~15-20 minutes

Dressing Change Tips

⚠️ Never use scissors near PICC
⚠️ Don't pull, bend, or kink catheter
⚠️ Let antiseptic air dry completely
⚠️ Change immediately if wet, dirty, or loose
⚠️ Inspect site at each change

Changing the PICC Cap

Cap Change Schedule

Every 7 days (weekly)

Supplies Needed

  • New IV catheter cap (needleless connector)
  • Alcohol pads
  • Trash can

Step-by-Step Cap Change

1. Prepare
  • Clean work surface
  • Wash hands
  • Gather supplies
2. Open New Cap
  • Carefully open sterile cap package
  • Leave cap in package (don't touch)
3. Ensure Catheter Clamped
  • Check clamp is closed
4. Clean Connection
  • Hold PICC lumen with alcohol pad
  • Vigorously clean catheter/cap connection with second alcohol pad for 15 seconds
5. Remove Old Cap
  • Carefully unscrew and discard
  • Don't touch open end of catheter
  • Don't place lumen down
  • Tip: Use rubber gloves or tape for better grip if stuck
6. Attach New Cap
  • Remove new cap from package
  • Unscrew protective covering (don't touch open end)
  • Screw onto catheter
For multi-lumen PICCs: Repeat for each lumen.
Total time: ~5 minutes per lumen

Protecting Your PICC

Activities to Avoid

❌ Swimming (pools, lakes, ocean)
❌ Hot tubs or saunas
❌ Contact sports (football, basketball, hockey)
❌ Vigorous arm activities:
  • Golfing
  • Bowling
  • Weightlifting
  • Archery
  • Repetitive arm motions
❌ Heavy lifting, pulling, pushing
❌ Activities where PICC could be grabbed or pulled

Showering & Bathing

✅ You CAN shower with proper protection:
Steps:
  1. Cover dressing and catheter with plastic
  2. Tape plastic edges securely to skin
  3. Keep arm away from direct water spray
  4. Keep shower brief
  5. Check dressing after shower
  6. Change dressing immediately if wet
⚠️ Never let catheter ends get wet

Safe Activities

✅ Walking
✅ Light housework
✅ Reading, computer work
✅ Driving (if approved by doctor)
✅ Most work/school activities
✅ Gentle exercise (with doctor approval)
When in doubt: Ask your clinician about specific activities.

Troubleshooting PICC Problems

1. Infection

Signs:
  • Fever and/or chills
  • Redness at insertion site
  • Swelling around PICC
  • Tenderness or pain
  • Drainage or pus
  • Warmth at site
What to do: 🚨 Call clinician immediately
  • Note color, odor, amount of any drainage
  • Don't remove PICC
  • Continue normal care until instructed otherwise

2. PICC Damage

Signs:
  • Visible break or tear
  • Puncture hole
  • Crack in catheter
Causes:
  • Repeated clamping in same spot
  • Excessive pulling
  • Contact with sharp object
  • Using small syringes to force flush
What to do: 🚨 Immediate action:
  1. Clamp PICC above damaged area
  2. Call clinician immediately
  3. Don't use PICC until repaired/replaced

3. Air Embolism (Air in Bloodstream)

Signs:
  • Shortness of breath
  • Coughing
  • Chest pain
  • Dizziness
Causes:
  • Tear or hole in catheter
  • Catheter not clamped when cap removed
  • IV tubing separated
  • Catheter cap fell off
What to do: 🚨 EMERGENCY - Act immediately:
  1. Clamp catheter and breathe slowly
  2. Lie on left side with feet elevated, chest/head lower than feet
  3. Attach syringe to catheter
  4. Unclamp and withdraw air until blood appears
  5. Flush with heparin
  6. Call doctor immediately

4. Blocked PICC

Signs:
  • Cannot flush
  • Cannot withdraw blood
  • Cannot infuse medication
  • Resistance when flushing
Causes:
  • PICC clamped
  • Kinked or curled catheter
  • Blood clot
  • Catheter against vein wall
What to do:
  1. Check for kinks - straighten if found
  2. Ensure unclamped
  3. Change position - move arms, shoulders, head
  4. If still blocked: Call clinician
  5. Never force flush - can rupture catheter

5. PICC Movement

Signs:
  • More catheter exposed than before
  • New pain in neck or shoulder
  • Catheter looks longer outside body
Cause:
  • Catheter migrated out of position
What to do: 🚨 Call clinician immediately
  • Don't use PICC until position confirmed
  • May need chest X-ray

6. PICC Comes Out

Signs:
  • Catheter partially or fully out of body
  • Bleeding from insertion site
Cause:
  • Excessive pulling
  • Dressing failure
  • Trauma to arm
What to do: 🚨 Immediate action:
  1. Apply firm pressure over insertion site
  2. Elevate arm
  3. Call clinician immediately
  4. Don't try to reinsert
  5. Save catheter if fully out

7. Thrombosis (Blood Clot)

Signs:
  • Arm swelling (PICC side)
  • Arm cool to touch
  • Swollen veins in neck or chest
  • Pain in arm, shoulder, or neck
Cause:
  • Blood clot in vein around catheter
What to do: 🚨 Call clinician immediately
  • May need ultrasound
  • May require blood thinners
  • PICC may need removal

8. Skin Irritation

Signs:
  • Redness under dressing
  • Tenderness
  • Blistering
  • Itching
Cause:
  • Allergic reaction to dressing or tape
What to do:
  • Call clinician
  • May need different dressing type
  • Avoid placing dressing over irritated skin
  • May need topical treatment

9. Fluid Leakage or Blood Backup

Signs:
  • Fluid leaking from catheter end
  • Fluid leaking along catheter
  • Blood visible in extension tubing or cap
Causes:
  • Loose connection between catheter and cap
  • Catheter damage (puncture or rupture)
What to do:
  1. Check connections - tighten if loose
  2. Flush PICC and observe exit site
  3. If leakage continues: Call clinician
  4. If catheter damaged: Clamp above damage and call immediately

When to Call Your Clinician

🚨 Call Immediately If:

  • Fever >100.4°F (38°C)
  • Chills or shaking
  • Shortness of breath or chest pain
  • PICC damaged or broken
  • PICC comes out
  • Signs of air embolism
  • Arm swelling (PICC side)
  • Severe pain at insertion site
  • Pus or drainage from site
  • PICC movement (more exposed)
  • Unable to flush after troubleshooting

📞 Call Within 24 Hours If:

  • Mild redness at insertion site
  • Dressing won't stay on
  • Skin irritation from dressing
  • Questions about care
  • Need supplies

PICC Care Checklist

Daily Tasks

☐ Flush with heparin (if not in use)
☐ Replace alcohol cap after flushing
☐ Inspect insertion site
☐ Check dressing is clean, dry, intact

3x/Week (Gauze Dressing)

☐ Change dressing (Mon, Wed, Fri)
☐ Inspect insertion site
☐ Clean site with antiseptic

Weekly Tasks

☐ Change clear dressing (every 7 days)
☐ Change catheter caps (every 7 days)
☐ Check supply inventory

Before Every Care Task

☐ Clean work surface
☐ Wash hands (15 seconds)
☐ Gather all supplies
☐ Check supplies for damage/expiration

Frequently Asked Questions

How long can a PICC stay in? Weeks to months, depending on need. Some stay in 6-12 months with proper care.
Does PICC care hurt? No. Dressing changes and flushing should be painless. Report pain to clinician.
Can I sleep on the PICC arm? Yes, but may be uncomfortable. Use pillows for support if needed.
What if I forget to flush? Flush as soon as you remember. If >24 hours late, call clinician before flushing.
Can I work with a PICC? Usually yes, depending on job. Avoid heavy lifting and vigorous arm use.
Will insurance cover supplies? Usually yes if PICC is medically necessary. Check with your insurance.
Can I drive with a PICC? Usually yes, but check with your doctor. Avoid if arm movement limited.
What if dressing falls off? Cover site with clean cloth and call clinician immediately. Don't leave site exposed.

Bottom Line

Proper PICC care at home prevents complications and allows safe, long-term IV therapy.
Key points: ✅ Wash hands before ALL care
✅ Flush daily with heparin
✅ Change dressings on schedule
✅ Keep site clean and dry
✅ Inspect daily for infection signs
✅ Call clinician for problems
✅ Never force flush or use damaged PICC
With proper care, most PICCs function well for their entire duration.

Key Takeaways

  1. Hand hygiene is #1 infection prevention
  2. Flush daily to prevent clots
  3. Change dressings on schedule (3x/week or weekly)
  4. Inspect site daily for infection signs
  5. Never use force when flushing
  6. Keep PICC dry during showers
  7. Call immediately for fever, damage, or air embolism
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