PICC Line Care at Home During Cancer

This page is for patients and caregivers looking after a PICC line at home during cancer treatment. It covers dressings, flushing, showering, and the warning signs that need a call.

A PICC is a peripherally inserted central catheter. MedlinePlus describes it as a long, thin tube that goes into your body through a vein in your upper arm. The end of the catheter goes into a large vein near your heart. It carries nutrients and medicines into your body. It can also be used to draw blood for tests.

The CDC guideline says not to replace PICCs and other central catheters on a routine schedule just to prevent infection. A line that works and shows no problem stays. The home routine is what protects it.

A dressing blocks germs and keeps the site dry and clean. MedlinePlus says to change it about once a week. Change it sooner if it gets loose, wet or dirty. The CDC guideline for healthcare settings says short-term central line dressings are changed at least every 7 days if transparent, and every 2 days if gauze. Follow the schedule your nurse gives you.

The CDC guideline says to clean the skin with a chlorhexidine preparation stronger than 0.5% with alcohol during dressing changes. MedlinePlus describes a kit with a chlorhexidine sponge called a Biopatch. Let the skin air dry before the new dressing goes on.

Two habits make each change safer. Wash your hands for 30 seconds with soap and water before you start. After the old dressing comes off, check the skin for redness, swelling, bleeding, or any drainage around the catheter. MedlinePlus says it is best to have someone help, because you need two hands.

Your clinic tells you the exact flush. MedlinePlus says to check that the strength and dose are correct. It says to ask your provider whether you also need a heparin flush. Get the plan in writing.

MedlinePlus describes this technique. Wash your hands for 30 seconds. Wipe the end of the catheter with an alcohol wipe. Inject the saline slowly by gently pushing on the plunger. Do a little, then stop, then do some more. Do not force it. Clean the end of the catheter again, then put the clamp back on. The CDC guideline says to scrub the access port with an antiseptic before using it.

MedlinePlus says not to let the catheter site go under water. The CDC guideline says showering is fine if you protect the catheter and connection with an impermeable cover. If the dressing gets wet anyway, it needs changing sooner.

Do not force a flush. MedlinePlus says to contact your provider if flushing is not working or if the catheter seems blocked.

Clinicians can use alteplase (Cathflo Activase), a clot-dissolving medicine that the FDA label describes as being for restoring function to central venous access devices. The label cautions about bleeding. It also says that using it in an infected catheter may release a localized infection into the bloodstream. A clinician decides whether it is right for you.

If you get a fever during chemotherapy, the CDC says to call your doctor immediately if your temperature is 100.4 degrees F (38 degrees C) or higher. The CDC says fever may be the only sign of an infection, and an infection during chemotherapy can be life-threatening. It says you should be seen quickly. Keep your care team's phone number nearby, and know which number to use when the office is closed.

Do not wait for a fever. The National Cancer Institute says infection can cause any of these signs: chills, cough or sore throat, diarrhea, ear pain, headache or sinus pain, a stiff or sore neck, skin rash, sores or a white coating in your mouth or on your tongue, swelling or redness where a catheter enters your body, and bloody or cloudy urine or pain when you urinate. NCI warns that infections during cancer treatment can be life threatening. They need urgent medical attention.

NCI says to talk with your doctor or nurse before taking medicine such as acetaminophen for a fever. These medicines can lower a fever but may hide signs of a more serious problem. NCI gives the fever mark as 100.5 degrees F. This page uses the lower CDC number, 100.4, to be safe.

MedlinePlus says to contact your provider if you have swelling in the arm below the catheter, or pain near the site or in your neck, face, chest or arm. Call your care team right away, at any hour. Do not wait for your next appointment. Swelling of the face or neck on the PICC side means going to an emergency department.

Keep supplies in one clean, dry place. Put these in writing where you can see them: your flush plan, the dressing change day, and both phone numbers, daytime clinic and after hours.

Ask the nurse who teaches you which arm to use for blood pressure cuffs and blood draws. Ask who does the dressing change if home health is involved. Ask what to do if you are traveling on a change day. Ask where to go after hours if the clinic is closed.

Ask for a return demonstration before you leave. The nurse shows you the flush, then you do it while the nurse watches.

• Call 911 or go to the nearest emergency department if the PICC has been cut, has broken off, or has pulled most of the way out, or if bleeding at the exit site keeps soaking through gauze despite steady pressure. Do the same for sudden trouble breathing, chest pain, or feeling faint. Do not drive yourself.
• Call 911 or go to the nearest emergency department if you have new confusion, or someone cannot wake you.
• Call 911 or go to an emergency department if your face or neck on the side of the PICC swells, especially with breathlessness or a flushed, puffy face. Do not drive yourself.
• Call your care team right away, day or night, if you have a temperature of 100.4 degrees F (38 degrees C) or higher, shaking chills, a sore throat, mouth sores, burning when you urinate, or pus, redness, warmth, swelling or tenderness at the exit site. Call right away for any other sign of infection, even without a fever. A normal temperature is not permission to wait. If nobody answers quickly, go to an emergency department. Tell the desk you are on chemotherapy and have a PICC line.
• Call your care team right away, at any hour, if the hand, arm or shoulder on the PICC side swells, aches or changes colour, or you have pain near the site or in your neck, face, chest or arm. This is how a catheter clot usually shows itself.
• Call your care team the same day if you notice leaking from the line, or if the catheter looks like it is coming out.
• Call your care team within a day or two if the line has become harder to flush or will no longer give a blood return, or if the dressing keeps lifting or getting damp between changes.

• CDC — Guidelines for the Prevention of Intravascular Catheter-Related Infections
• CDC — Watch Out for Fever (Preventing Infections in Cancer Patients)
• MedlinePlus — PICC line, dressing change
• MedlinePlus — PICC line, flushing
• MedlinePlus — PICC line, insertion
• FDA — Cathflo Activase label
• National Cancer Institute — Infection and Neutropenia During Cancer Treatment