Cancer and chemotherapy – Will you need a PICC line?
There is a number of different ways chemotherapy can be delivered as part of your cancer treatment. Some are more common than others, and it usually depends on the type of cancer you have, where the cancer is in the body and the particular drug or drugs you’re having.
One method to administer chemotherapy is through a PICC line. In this post, we’ll be looking at the role a PICC line has when you have cancer.
What is a PICC line?
PICC lines (peripherally inserted central catheters) are used to give someone chemotherapy treatment or other medicines.
A PICC line is a long, thin, flexible tube called a catheter. It’s put into one of the large veins of the arm, above the bend of the elbow. Then it is threaded into the vein until the tip is in a large vein just above the heart (see illustration below).
The line is usually sealed with a special cap or bung. This can then be attached to a drip or syringe containing your chemotherapy or medication.
Why should I have a PICC line?
A PICC line can be used to give you treatments such as:
- Blood transfusions
- Intravenous (IV) fluids
- Liquid food if you’re not able to eat
Some drugs such as chemotherapy can cause discomfort or pain to the vein. A PICC line can reduce irritation in the veins by delivering the chemotherapy straight into a big vein and to make sure that the chemotherapy is given safely. It also allows for the medications, fluids and antibiotics to be given directly to the bloodstream. It can be used for blood taking which reduces the need for taking blood directly from the arm.
A PICC is ideal for people with small veins or who are scared of needles. It can also be used as a temporary central line, especially for people who need to start intensive treatment immediately or need a different type of line but are unable to have one because they are on blood thinning medication or are unable to lie flat.
How is the PICC line put in?
A specialist nurse or doctor will put in your PICC line in an outpatient department or on a ward. They will discuss with you which arm would be better to use.
First, the skin in the area is cleaned with antiseptic solution. Then this area is numbed with an anaesthetic cream or injection.
When the skin is completely numb, a needle will be put into the vein. Your doctor or nurse may use an ultrasound scan to help them find the best vein to use. The ultrasound uses sound waves to produce a picture of the veins in your arm. A small hand-held device is rubbed gently over your arm. This is painless.
The PICC line is threaded through the needle into a large vein that leads to your heart. The needle is removed at the same time. This shouldn’t take long and is usually painless. The PICC line will be held in place by a clear dressing.
You will have a chest X-ray to check that the end of the tube is in the right place.
What happens after the procedure?
Once the local anaesthetic wears off, you may feel some slight discomfort or achy feeling in the arm where the PICC has been inserted. This is quite common. Most people do not need any pain relief but if you need to, you should be able to take your usual painkillers. There may also be some bruising and blood on the dressing. This is nothing to worry about. In some cases, there may be some tenderness or swelling around the insertion site. This is quite common, especially during the first week of insertion.
How long will I have the PICC?
You can have a PICC line for weeks, months, or years depending on your treatment. Your doctor or nurse will determine this duration.
What are the risks of PICC insertion?
As with most procedures, there is a small risk of complications
which may include:
- Infection – there is a small risk of infection after having a PICC inserted.
- The catheter tip in the vein may not be in the correct position and sometimes needs to be adjusted into a better position.
- Bleeding and some bruising around the insertion site, especially in people whose blood does not clot normally.
- Accidental puncture of the artery which may cause bleeding.
- Nerve damage – during the procedure you may feel a shooting pain down your arm if the needle touches a nerve.
For more information on cancer treatment, including chemotherapy, radiotherapy, and mastectomies, you can visit our Expert Guides page.