PICC Line: A Cancer Treatment Chemotherapy Port

Almost immediately after diagnosis of his blood plasma cancer (Multiple Myeloma), the author’s oncologist wanted to immediately (if not sooner) have a PICC Line inserted in his arm. Because the doctor could not make the necessary arrangements on such short notice, the start of the author’s chemotherapy regimen was postponed for one week. It needed to start on a Friday, but the soonest they could insert the PICC line was Monday. So the start date of the chemo had to be delayed.

The term PICC stands for “peripherally inserted central catheter.” Effectively, it is a port that allows the medical staff easy access to the blood stream (specifically to the veins) without the need to insert a new IV each and every day of chemotherapy. Although it is considered to be a “temporary” port, it can remain in place for several months.

The PICC line itself is a plastic device with ports to which IV tubing can easily be connected. In the author’s case, there were two such ports, called lumens connected to the anchor piece. These in turn connected to a single long, small diameter tube with a tiny internal diameter. The length of this tube varies, but in the author’s case, it was about 18 inches long. The line was inserted through the skin on the inside of his upper left arm. The thin tube passed through his skin and into the vein where the long tube was allowed to slide through the vein towards the heart. The business end of this tube was positioned in the big veins near the main entrance to the heart.

The base of this unit (which connected the long tube to the two lumens) was a quarter-sized chunk of plastic with two flanges on opposite sides. A single hole in each flange allowed the device to be mechanically snapped into an anchor bracket that was fastened on the inner arm with strong adhesive. The anchor bracket and the protective dressing needed to be checked and changed weekly.

From the patient’s point of view, two lumens dangled at all times from the bracket where they could easily be reached and utilized by the chemo nurses. They could easily attach IV lines to these lumens and either draw blood or put medications into the blood stream. Even though the lines were attached on the upper arm, the business end of the PICC line allowed all medications to be deposited into the blood stream near the heart.

How did they use the PICC line? Each day after arriving for chemotherapy, they wiped the end of each lumen with an alcohol swab and inserted and fastened the IV tubes. For a period of about 6 months, the author did not need to have IVs puncture his lower arm to draw blood. All blood work and chemo procedures were performed by connecting to the lumens. Blood flowed out very nicely, and chemo medications flow in nicely as well. Other than not being allowed to get any water on that part of the upper arm during showers, the PICC line was quite convenient.

How was the PICC line inserted? Although the author was not paying close attention to the details of this procedure, a nurse practitioner inserted the line into his arm in a hospital room. The author was comfortably lying in a standard hospital bed with his left arm up and hanging off the top end of the bed. The nurse practitioner numbed the area on the arm, determined how long the tube needed to be, and inserted the tube. The whole procedure took about 15 minutes. The final step was to have an X-ray taken to make sure the end of the tube was positioned properly near the heart. The author waited longer for the X-ray results than it took for the nurse practitioner to insert the PICC line.

Was the PICC line used for other things than the administration of chemo medications at the cancer clinic? The fact that the PICC line was a semi-permanent attachment (meaning it was available 24/7 for extended numbers of days), it was possible to connect its lines to portable pumps which could administer chemo drugs continuously for the four days of each chemo cycle (start Monday, end Friday). During each cycle of chemo, they connected the lumens to two portable pumps which were in a hand bag that the author carried over his shoulder wherever he went and that he hung on the headboard of the bed at night. Relatively long tubes connected the pumps to the PICC line for convenience. The tubes were fed under the shirt near the waist, up through the armpit hole of the shirt, and connected to the lumen. This allowed shirts to be changed easily while the pumps were in use.

How can one shower without getting water onto the entry point on the upper arm? The author simply wrapped his upper arm with standard kitchen plastic wrap and then taped the edges of the wrap with packing tape. When finished showering, the tape was pulled off and the plastic wrap removed. This worked well.

The more difficult procedure was keeping the bag containing the pumps from getting soaked during showers. To accomplish this, the author stretched the tubes up and over the shower curtain rod to the bag which was also hanging on the outside of the curtain from the shower rod. This worked fine as well.

How was the PICC line removed? Believe it or not, the nurse simply had to pull on the line and the long tube slid right out. Pressure needed to be applied to the upper arm for about 5 minutes after the PICC line was removed, but it was a very simple procedure. The author was nervous about the procedure because they used anesthetic to insert the line, but they said they needed none to remove it. Turns out, it came out easily without any feeling whatsoever. The nurse said she’d pull it out on 3, “one, two,… three!” and it was out. Looking away on “three,” the author looked back to a grinning nurse with the line dangling in her fingers. Everything went very smoothly.

It would have been nice to know most of this when they originally said they needed to insert a PICC line, but now that its over — the whole procedure was no big deal — and the PICC line itself was very convenient and handy during the chemotherapy treatments. The author’s conclusion: his anxieties over all of these procedures was for naught. If and when he needs to use another PICC line, he will enter the various procedures in a much more relaxed frame of mind.