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PICC or Midline Placement

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What is a PICC or a Midline IV?

IVs are soft catheters (tubes) placed in veins. A needle is used to pierce the skin. The needle is removed once the tube is in the vein.

Midlines are longer than a regular IV. Midlines are usually put into a vein in the arm. Sometimes a leg vein is used for infants. It lasts longer than a regular IV, but not as long as a PICC line. It can usually be used for 2-4 weeks. Midlines are used for medications or fluids that do not irritate veins.

PICC stands for peripherally inserted central catheter. It is put into a large vein in the arm and ends in a large vein near the heart. Sometimes a leg vein is used for infants. A PICC can be used for longer periods of time than a midline. PICC lines are used to give IV medications or IV fluids that can irritate veins. If your child needs a PICC, the doctor will explain the reason your child needs the procedure. One of the Vascular Access Team (VAT) nurses will explain the procedure to you and then will ask you to sign a consent form.

Why does my child need a  Midline or a PICC?

  • Good veins for regular IVs are not available.
  • Your child has had severa IVs placed which did not last long. This will decrease the number of "sticks" for your child.
  • Your child will need IV medication or IV fluid for __________ days or _______ weeks.

What will happen when my child goes for Midline or PICC placement?

  • The nurse will apply a medicated numbing lotion or give your child an injection with numbing medication before the procedure. These medicines will decrease the discomfort of Midline or PICC placement.
  • If your child is getting a PICC line, the nurse will also give a medication to help him/her relax.
  • Your child will go to a treatment room with a nurse trained for placing these types of IVs.  
  • If your child is anxious, a Child Life staff member can come to help your child during the procedure.  
  • Your child will be placed on an exam table.
  • The nurse will clean your child’s arm with an antiseptic soap.
  • The nurse will place drapes over your child. It is important that your child does not touch the drapes.
  • A small needle is used to get the soft catheter into the vein. Once the nurse is sure the Midline or PICC is in the vein, the needle will be removed. 
  • An x-ray is taken to check for placement of PICC lines.
  • A bandage will be put over the area where the midline or PICC was placed.
  • Your child will return to his/her room.

What are the possible complications from having a PICC or Midline?

  • Air in line: A large amount of air in the line can be dangerous. Your home health nurse will show you how to get air bubbles out of the syringes and medication tubing.
  • Bleeding: If the line is opened when it is not clamped or connected to a syringe, blood can be lost from the vein. Make sure to clamp the line when it is not in use, and check that the caps are secure.
  • Blocked catheter: If this happens you will feel pressure when you try to give fluid from a syringe into the catheter. It could be from a clot that formed in the catheter. You should not force the syringe when you are flushing. Flushing your child’s line per your home health instructions will help to prevent blockage. 
  • Infection: Washing your hands before caring for your child’s line is very important. Using good hygiene for changing the dressing and caps can also decrease the risk of infection. Signs of infection are fever, redness at the site, pus from the site, swelling or pain.
  • Bruising: If the bruise is large, painful or swollen the doctor or home health nurse will need to remove the catheter and start another line.
  • Phlebitis: If you notice your child’s vein feels like a cord and is warm and painful to touch, the line may need to be removed by the doctor or nurse. Phlebitis is caused from the vein being irritated from the catheter or the medication.
  • Catheter migration: Keep the bandage secure and follow the activity limitations. This will help to keep the line from moving out of the area of the vein where it was placed. Movement of the catheter can cause pain and irritation. Rarely, a piece of the catheter may break off inside the vein. This is more common in small catheters used for infants. A foreign piece of material in the blood stream is dangerous. Please seek medical attention immediately.
  • Infiltration: If the catheter pokes through the vein or comes out of the vein, the fluid will go into the tissues. This will cause the area to swell and it might be red and painful. Do not use the catheter if these signs are present. If you are giving medication or IV fluid by a pump, stop the pump.

Call your doctor or home health nurse if your child has any of these complications.

Activity limitations for a PICC or Midline:

  • The arm or leg with the line cannot be placed under water. Keep the bandage dry.
  • No tumbling or rough play
  • No repetitive arm movements such as bouncing a ball
  • Avoid activities that will get the bandage dirt

If your child goes home with a PICC or Midline: A home health care nurse will visit your child and teach you how to:

  • Change the cap
  • Flush the line
  • Give your child’s medications

How is the Midline or PICC removed?

 When your child’s doctor decides the IV is no longer needed, a nurse or the doctor will:

  • Remove the bandage
  • Take out the catheter (long tube)
  • Clean the area with antiseptic soap
  • Place a small bandage over the area. Keep the bandage on your child for 1 day or until the area is healed.

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 07/2014

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