PICC Lines – Waterproofing, Securement, Skin Reactions

PICC Lines – Waterproofing & Securement

A peripherally inserted central catheter (PICC line) is a long, thin tube that is inserted into a vein in the right upper arm and extends to the superior vena cava, just outside the heart. PICC lines usually have two ports through which fluids, medications, and blood products can be infused. PICC lines allow patients to continue IV therapy at home—something that cannot be safely accomplished with standard IV catheters or traditional central lines. While PICC lines are generally safe for home use, proper PICC line securement and use are essential. 

Why are PICC lines used in medicine?

In a hospital setting, intravenous (IV) medications are infused through a standard, short IV catheter. This is the typical IV catheter used in virtually every hospitalized patient. Standard IV catheters are great for most applications, but they are not useful in two situations. Standard IV catheters cannot be used to infuse medications that irritate veins, nor are they safe for repeated, at-home IV infusions. 

Some medications are irritating to veins if they are infused through standard IV catheters. The veins in the arm or leg are so narrow that if drug was infused through a standard IV catheter, it would cause pain and inflammation at the IV site. Because they are so short, standard IV catheters aren’t very secure and tend to move out of the vein. This makes them impractical for long-term use.

Healthcare professionals overcome this problem by using PICC lines, which are long catheters that extend from the arm vein to a large blood vessel near the heart. PICC lines are useful because even irritating medications infused through these lines do not irritate large diameter veins near the heart. PICC lines are safer for home use than traditional central lines because they enter the body through small peripheral veins rather than large central veins. PICC lines are also much more secure and stable than short IV catheters, and can standup to weeks of repeated use.

PICC lines are used in several conditions

PICC lines are used to infuse certain IV medications and blood products. PICC lines are commonly used to administer cancer chemotherapy, which needs to be infused over weeks or months and can be irritating to veins. PICC lines can also be used to administer long courses of certain IV antibiotics, such as vancomycin. Another common reason to use a PICC line is to administer total parental nutrition or TPN. Total parental nutrition is a mixture of carbohydrates, proteins, fats, vitamins, and minerals that are administered intravenously. TPN can provide nutrition for people who cannot eat food by mouth.

Someone may have a PICC line placed if they need ongoing IV therapy but have no other reason to stay in the hospital. A PICC line is usually placed if the patient needs IV therapy for more than a few days, up to 6 months.1 

Why PICC lines fail

PICC lines are excellent choices for intermediate-term venous access, but the proper use of PICC lines is essential to keep them from failing. PICC lines can fail (and usually must be removed) for several reasons.2

  • Infection – Since the catheter passes through the skin and enters the bloodstream, there is always some risk of infection (e.g. catheter-associated bloodstream infection or CABSI). Patients and caregivers should be meticulous about keeping the tip of the PICC line as close to sterile as possible. Caregivers should touch the PICC line as little as possible, and only do so with clean, gloved hands. 
  • Phlebitis – The catheter itself may irritate the vein, causing phlebitis. Keeping the PICC line immobile may reduce the risk of phlebitis. Phlebitis can sometimes be treated with NSAIDs and warm compresses (i.e. PICC removal may not be needed).1
  • Occlusion – The catheter may become occluded (blocked) for three reasons: blood clots, drug precipitates, malposition. Properly flushing the line can reduce the risk of blood clots and medication precipitation, while proper PICC line securement can reduce the risk of malposition.
  • Catheter Migration – Catheter migration occurs when the tip of the PICC line moves out of its intended position. It may occur during placement (primary migration) or afterwards (secondary migration). Proper PICC line securement can prevent catheter tip migration.1

Primary and secondary PICC line securement

As you can see, proper PICC line securement can help reduce the risk of several types of PICC line failure including secondary catheter migration, occlusion through malposition, and phlebitis. PICC lines are not “tunneled,” so securement and stabilization depend on how well the healthcare professional can anchor the end of the line to the arm. In truth, medical tape must do all of the work of stabilizing the end of the PICC line.

Carol Czajka, BSN, RN, CPN, VA-BC and colleagues have discussed the importance of both primary and secondary PICC line securement. Primary PICC line securement—sometimes called stabilization—is the medical adhesives that hold the end of the PICC line in place. Secondary PICC line securement, on the other hand, are the steps taken to prevent other lines from pulling on the catheter. For example, a clear adhesive covering may be used as primary securement to keep the external end of the PICC line firmly attached to the skin. Medical tape is then used to reinforce the primary securement and anchor the IV lines that are attached to PICC line. Primary securement cannot withstand the force of IV lines being caught on a bed rail and pulled, but secondary reinforcement can. Both primary and secondary PICC line reinforcement are critical to ongoing successful PICC line use.  

Hy-Tape is the ideal medical tape for secondary securement of PICC lines

Hy-Tape—The Original Pink Tape®—is strong enough to provide excellent secondary securement for PICC lines. It conforms to the shape of skin surfaces and adheres even more tightly as it warms to body temperature. Despite its strength, Hy-Tape releases cleanly and with little to no skin trauma. This, it can be easily removed from lines and skin. This is important, because any medical tape used for PICC line securement must be strong on lines, but gentle on skin.

Hy-Tape may be useful for primary PICC line securement

While clear dressings are commonly used for primary PICC line securement, they contain latex and adhesives that may provoke allergic reactions. An allergic reaction at a PICC line site can have devastating consequences since the area can become so inflamed that no adhesives can be used. No adhesives mean no securement, and no securement means no PICC line.

Because Hy-Tape is latex free and has a soothing, zinc-oxide based adhesive, it can be used as primary PICC line securement for patients with a documented or suspected latex allergy or otherwise sensitive skin. Healthcare professionals can use Hy-Tape under and over the exposed PICC line to stabilize it on the skin while still allowing free access to the PICC line ports. As discussed previously, Hy-Tape can also be used for secondary PICC line securement.  

Device securement articles:

References

1. Gonzalez R, Cassaro S. Percutaneous Central Catheter (Picc). Statpearls [Internet]: StatPearls Publishing; 2018.

2. Grau D, Clarivet B, Lotthé A, Bommart S, Parer S. Complications with Peripherally Inserted Central Catheters (Piccs) Used in Hospitalized Patients and Outpatients: A Prospective Cohort Study. Antimicrobial resistance and infection control. 2017;6:18-18. doi:10.1186/s13756-016-0161-0