PICC: ‘Life’lines of children with cancer
Central venous lines/catheters are very important in managing patients with cancer who require long-term intravenous medications, fluids and blood products. It helps in avoiding repeated pricks for intravenous access, in decreasing the incidence of skin burns from vesicant medications. It also plays a crucial role during infections and complications when finding a peripheral line and putting a cannula may be difficult. It makes providing intravenous nutrition easier.
What is PICC?
A peripherally inserted central venous catheter (PICC) is a type of central venous catheter which is placed in a large vein in the upper arm, which connects it to the heart. It generally has a single lumen and rarely 2 lumens. It is advantageous over the conventional central venous lines due to ease of insertion and longer catheter life.
Why does your child need it?
To avoid repeated needle pricks for taking blood samples. It makes administration of chemotherapy, blood products, nutrition and other important medications during cancer treatment; a smooth process.
How is a PICC line put?
It is put by trained doctors or nurses after giving local anesthesia. Best veins in the upper arm (cubital fossa) are used for insertion. Sometimes if the veins are poor, then ultrasound guidance is required. It is a bedside procedure and does not require sedation or surgery; though smaller children may require mild sedation. It is secured with sutures or sometimes a suture-less stabilization device stat lock is used. The procedure generally takes 15-30 minutes. A Chest X-ray is done at the end for the final position of the PICC tip.
What are the advantages of PICC over other lines?
Ease of insertion and cost-effective. They can be used for up to 6 months or even longer if proper care is taken. Removal is also easy and can be done bedside.
What are the disadvantages of PICC?
Chances of local site infection and bloodstream infection. Breakage and leakage, dislocations, occlusion can occur. In children, accidental dislodgement and removal are also known complications.
What are the other options?
Implantable ports and Hickman catheters are also used for long-term use and have lower chances of infection; though costly as compared to PICC. Both of them require a small surgical procedure for insertion. Hickman catheter is generally preferred for children undergoing transplants.
How do I take care of a child’s PICC?
Taking care of PICC is the shared responsibility of both the doctors and nurses as well as the parents. To avoid infections and blockage, dressing and flushing of the lines need to be done weekly. Parents are also taught how to do it at home and it should be done with clean hands. Avoid soakage of the line, cover it during bath. Alert your doctor or nurse if the area around the PICC insertion shows redness or discharge.
Childhood cancer is curable if diagnosed on time and treated properly.
Take care of the ‘lifelines’, to make treatment of cancer a happy journey for a child!!
Author: Dr. Megha Saroha, Associate Consultant – Paediatric Oncology, Dharamshila Narayana Superspeciality Hospital, Delhi