Understanding PICC Lines and Home Discharge
A peripherally inserted central catheter (PICC) is a long, thin, flexible tube inserted into a vein in the upper arm [1.3.6]. The tip of the catheter is advanced to a large vein near the heart [1.6.6]. This allows for the long-term administration of medications, intravenous fluids, blood products, or nutrition without the need for repeated needle sticks [1.2.2].
Discharging patients with a PICC line is a common and effective practice known as Outpatient Parenteral Antimicrobial Therapy (OPAT), which allows individuals to complete long courses of IV therapy in the comfort of their own home [1.5.7]. This approach can reduce hospital costs, lower the risk of hospital-acquired infections, and improve a patient's quality of life [1.5.1]. The most frequent reason for a PICC line is the need for long-term antibiotics [1.4.8, 1.7.1]. Other common uses include chemotherapy, blood transfusions, and total parenteral nutrition (TPN) [1.2.2].
Criteria for a Safe Discharge
Before a patient can be discharged with a PICC line, healthcare providers must ensure they meet specific criteria. The patient must be clinically stable and responding well to therapy [1.5.1]. A crucial part of the discharge process is comprehensive education for the patient and their caregivers [1.3.6]. This training typically covers:
- Hand Hygiene: The most critical step to prevent infection is proper hand washing before and after touching the PICC line or supplies [1.3.1].
- Flushing the Line: The catheter must be regularly flushed with saline (and sometimes heparin) to prevent clots and blockages. This is often done using a specific "push-and-pause" method [1.3.4].
- Dressing Changes: The sterile dressing over the insertion site needs to be changed weekly, or sooner if it becomes wet, loose, or soiled [1.3.8]. A home care nurse usually performs this task, though some patients or caregivers may be trained to do it [1.3.3].
- Identifying Complications: Patients must know the signs of infection (fever, chills, redness, swelling), blood clots (arm swelling, pain), and catheter damage (leaks, cracks) and when to contact their healthcare provider immediately [1.2.6, 1.4.4].
Home Care and Daily Life with a PICC Line
Living at home with a PICC line requires some adjustments to daily routines. The primary goal is to keep the line clean, dry, and secure [1.3.1].
- Activity Restrictions: Patients should avoid lifting heavy objects (typically more than 10 pounds) with the arm that has the PICC line [1.2.1, 1.3.1]. Repetitive arm motions like vacuuming or playing golf should also be avoided [1.2.6]. Normal daily activities are generally encouraged to help prevent blood clots [1.3.1].
- Bathing and Showering: The PICC site and dressing must be kept dry at all times. Showers are permissible if the site is protected with a waterproof cover. Submerging the line in water, such as in a bathtub, pool, or hot tub, is prohibited to decrease infection risk [1.2.1, 1.3.1].
- Safety Precautions: Never use sharp objects like scissors near the catheter [1.3.2]. The line should be secured to the arm to prevent it from snagging on clothing or other objects [1.3.7]. Patients should also keep pets away from the PICC line [1.3.2].
PICC Line vs. Midline Catheter for Home Use
When planning for outpatient IV therapy, a provider might consider a midline catheter as an alternative to a PICC line. While their care is similar, their placement and use cases differ [1.6.2].
| Feature | PICC Line | Midline Catheter |
|---|---|---|
| Catheter Tip Location | Ends in a large central vein near the heart [1.6.6]. | Ends in a peripheral vein below the shoulder; does not reach central circulation [1.6.6]. |
| Ideal Duration | Weeks to months; suitable for long-term therapy [1.2.2, 1.6.7]. | 1 to 4 weeks; better for short-to-medium-term therapy [1.6.5, 1.6.7]. |
| Medication Types | Can administer highly concentrated or irritating medications (vesicants) [1.6.2, 1.6.7]. | Best for non-vesicant medications and hydration [1.6.6]. |
| Complication Risk | Higher risk of central line-associated bloodstream infections (CLABSIs) and deep vein thrombosis (DVT) [1.6.6, 1.6.7]. | Lower risk of major complications like infection and thrombosis compared to PICCs [1.6.6, 1.6.7]. |
One study found that for outpatient antibiotic therapy, midlines were associated with a lower risk of adverse events compared to PICCs [1.5.3]. The choice depends on the type of medication needed and the expected duration of treatment [1.6.7].
Potential Complications at Home
While generally safe, PICC lines carry risks. A multi-center study found that a significant number of patients report issues after discharge, including signs of possible bloodstream infection (17.6%) and deep vein thrombosis (30.6%) [1.7.3, 1.4.8]. Patients and caregivers must be vigilant for signs of trouble.
When to Call Your Healthcare Provider Immediately:
- Fever of 100.4°F (38°C) or higher, or chills [1.2.6].
- Redness, swelling, pain, warmth, bleeding, or drainage from the insertion site [1.2.1, 1.4.4].
- Swelling in the hand, arm, neck, or face on the side of the PICC line [1.2.6, 1.4.4].
- Chest pain or shortness of breath [1.2.6].
- The catheter has cracked, is leaking, or appears to have moved in or out [1.4.2, 1.4.4].
Conclusion
Discharging a patient with a PICC line is a standard of care that enables effective and convenient long-term IV therapy at home. Success hinges on a stable patient, a robust education plan, and a support system that includes home health nursing. By understanding how to care for the line, adhering to activity restrictions, and promptly recognizing signs of complications, patients can safely complete their treatment outside of the hospital. Continuous communication with the healthcare team is essential to managing the PICC line and ensuring a positive outcome.
For more information, you can consult resources from the Association for Professionals in Infection Control and Epidemiology (APIC).
