PICC Lines
A peripherally inserted central catheter (PICC) is a central line placed through a peripheral vein and advanced to the central circulation. This page gives a quick nursing overview of why PICCs are used, how to assess them, and key safety steps to prevent complications.
What Is a PICC?
A PICC is a type of central line.
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It is inserted through a peripheral vein in the arm (often basilic, brachial, or cephalic).
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The catheter is advanced until the tip rests in the lower superior vena cava or cavoatrial junction.
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Because the tip sits in central circulation, a PICC is considered a central venous catheter, even though the insertion site is in the arm.
About PICCs
Why Do We Use PICCs?
PICCs are used when patients need reliable, longer-term IV access or medications that should not go through a short peripheral IV. Common reasons include:
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IV antibiotics for several days to weeks
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Total parenteral nutrition (TPN)
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Certain chemo or irritant/vesicant medications (per policy)
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Poor peripheral access or frequent blood draws
PICC Line – Nursing Assessment Checklist
Each shift and before using a PICC, assess:
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Site: redness, swelling, warmth, tenderness, drainage, bleeding
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Dressing: clean, dry, intact; dated; securement device in place
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Line & connections: no kinks or tension, hubs/caps secure, clamps correct
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Patency: flushes per protocol with expected blood return (per policy)
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External length: any change from documented baseline
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Patient: pain at site, arm swelling, neck/chest discomfort, SOB, chest pain
Daily PICC Care & Safety Steps
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Perform hand hygiene before and after PICC care.
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Use aseptic technique for all dressing and cap changes.
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Keep the dressing clean, dry, intact; change per policy or if loose/wet/soiled.
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Scrub the hub before every access.
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Ensure the line is well secured with no tension or pulling.
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Check tubing, clamps, labels, and follow flush protocol.
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Teach the patient not to pull on the line, support the arm, and report pain or swelling.
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Document PICC assessments and interventions.
Section: Case Scenario
Case Scenario: Possible PICC Occlusion:
You are flushing a patient’s PICC and notice increased resistance. The patient reports mild discomfort in theupper arm and the arm looks slightly more swollen than yesterday. The dressing is intact and dry.
What should the nurse do first?
A) Force the flush to “clear the line”
B) Stop the flush, assess the arm/site, compare bilateral arm size, and check for pain, warmth, or redness
C) Remove the dressing to inspect the insertion site
D) Start a new peripheral IV and ignore the PICC for now
Best answer: B
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Rationale : Do not force a flush. Stop and assess for possible thrombosis, malposition, or developing complication. Verify patency per facility protocol and notify the provider/IV team if abnormal findings or persistent resistance are present.
Section: Safe vs Unsafe
Safe vs Unsafe (Quick Examples)
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SAFE: Scrub the hub, use aseptic technique, flush per policy, keep dressing clean/dry/intact, andlabel/trace tubing.
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UNSAFE: “Topping off” caps/tubing without hub scrubbing, leaving loose/damp dressings, forcing a flush,or ignoring new swelling/pain/fever.
Section: Knowledge Check
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1) Which finding is most concerning for a PICC complication?
A) Dressing edges are lifting slightly
B) New arm swelling and pain on the PICC side
C) Patient says saline tastes “weird” when flushed
D) Patient wants the dressing changed early
2) The nurse meets resistance when flushing a PICC. The best action is to:
A) Force the flush
B) Stop, assess, and follow facility protocol for patency/troubleshooting
C) Remove the line immediately
D) Skip flushing for the rest of the shift
3) The most important daily PICC assessment includes checking:
A) Only the pump settings
B) Arm circumference, pain, warmth, dressing integrity, and signs of infection
C) Patient appetite
D) Patient’s bowel sounds
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4) Which action best helps prevent infection?
A) Changing caps without scrubbing the hub
B) Scrub the hub and use aseptic technique during access
C) Letting the dressing get damp after a shower
D) Reusing alcohol pads
5) A damp PICC dressing should be:
A) Left alone if it is “mostly stuck”
B) Reinforced with tape only
C) Changed per facility policy using sterile/aseptic technique
D) Removed and left open to air
Section: Reflection Questions
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Reflection Questions
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1) What is one warning sign that would make you notify the provider/IV team right away?
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2) What is one step you will be more consistent with during daily PICC assessments on your next shift?
References:
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Brodnik, J. E., Lieux, S. M., Serrano-Smith, M., Bena, J. F., & Siedlecki, S. L. (2023). PICC Line Occlusions: Implications and Opportunities for Medical-Surgical Nurses. MEDSURG Nursing, 32(5), 305–310.
Ferraz-Torres, M., Diez-Revilla, A., Plaza-Unzue, R., & Inés Corcuera-Martinez, M. (2024). Analysis of complications associated with peripherally inserted central venous catheters. Prospective observational study. Revista Cuidarte, 15(3), 1–10.
Zhang, F., Ye, G., Chen, P., & Gui, Z. (2024). Comparative Predictive Modeling for PICC Line Complications in Oncology: A Retrospective Study. British Journal of Hospital Medicine, 85(9), 1–15.
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One of the images used on this site, adapted from Together by St. Jude. (n.d.). Tunneled central line. https://together.stjude.org/en-us/treatment-tests-procedures/procedures/central-venous-catheters/tunneled-central-line.html
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One of the images used on this site, adapted from National Cancer Institute. (n.d.). Peripherally inserted central catheter. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/peripherally-inserted-central-catheter