PICC Lines and Their Use in the NICU

Premature infants have a variety of unique needs, depending on how early they are born. Some will require assistance breathing, eating and taking fluids and others may require medications or other medical interventions. Your baby's care team may recommend a peripherally inserted central catheter, also known as a PICC line, if he or she can't take nutrition and fluids through breast or bottle-feeding, or needs longer-term medications or other IV-administered medications.

What Is a PICC Line?

A PICC line is a long, soft, plastic tube inserted into a large vein in the baby's arm or leg. The line is guided up into a large vein near the heart where it can deliver medications such as antibiotics or chemotherapy) and/or total parental nutrition (TPN). The procedure for inserting a PICC line takes about 1 to 2 hours to complete.

A PICC line is similar to a peripheral IV, but is longer and lasts longer. Premature infants have fragile veins, and peripheral IVs usually last only 1 to 3 days. A PICC line, though more difficult to insert, can be used for 1 to 2 weeks or more.

After the PICC line is placed and secured to the skin to prevent it from dislodging (sometimes with stitches), the area is covered with a sterile dressing to prevent infection. A chest x-ray will be taken to ensure that the PICC line is in the correct location.

Why Does My Baby Need a PICC Line?

While it might seem scary at first, a PICC line can help your baby grow and be healthy. In addition, it has many other advantages, including:

• It is more comfortable compared to experiencing many needle sticks that would otherwise be necessary for giving medications and drawing blood. With a PICC line, your baby will be spared this extra pain
• Avoiding the irritation to veins and blood vessels from IV medications
• The ability to stay in place for long periods of time (weeks or months), if needed
• Safe and effective delivery of many different types of IV treatments, such as providing nutrition and medications
• Easy access to blood for testing

Risks

Most health care professionals that place PICC lines are very experienced and the procedure is safe and well-tolerated. However, there are certain risks to consider. These include:

• The possibility that it may take several attempts to place the PICC and, in some cases, the inability to properly position the PICC line, requiring different therapy.
• A small risk of infection: The risk increases with the amount of time the PICC is in place.
• Wearing away of the blood vessel wall from contact with the catheter. If this happens, IV fluid or medication can leak into adjacent areas of the body.
• Wearing away of the wall of the heart, which can cause life-threatening bleeding and compromise heart function.
• Blood vessel breakage from the catheter.