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Excellence in Vascular Access Education
since 1992

FAQ

Welcome to the FAQ

Feel free to ask FAQ a question directly or peruse all the questions and tutorials in the archives
Question Lady
Common Problems with PICCs
There are common reasons for PICCs to become blocked. Contact your doctor or nurse who can help overcome most of these problems. Here are a few common reasons for blockages:
  • Blood clots in the blood vessel around your PICC may cause blockage. Clots can plug the catheter making infusions difficult. Sometimes you can infuse your medicines but are unable to get blood out. This may be caused by a fibrin sheath, which is tissue your body deposits on the catheter. Both of these problems can be treated with clotbusting drugs given through the PICC which help dissolve the clot or sheath. Sometimes, the catheter needs replacement or other methods are used to restore catheter function (including angioplasty, or ballooning).
  • Mechanical blockages or malpositions can occur when a catheter is in the wrong place in a blood vessel, is kinked or pinched, or is broken. This can happen if your CVAD has accidentally come out part of the way or been pushed in too far. Sometimes the catheter can be repositioned to restore function.
  • Residue or precipitate build-up inside the PICC can also cause blockage. This can occur if medications interact with one another, if they leave behind a residue, or if your PICC is not flushed properly. Sometimes solutions can be injected into your PICC to dissolve the residue. A blood clot can plug the catheter making infusion difficult.
Infection Infections are caused by germs getting in or around a PICC and become a serious problem if not treated promptly.

Make sure to check daily for:

  • Redness, swelling, warmth, tenderness or drainage where the PICC enters or exits your body. You may have a local infection.
  • Fever, chills, vomiting, diarrhea, fatigue, weakness and loss of appetite may be signs that there is an infection in your bloodstream. If any of these occur, contact your doctor or nurse immediately.
Phlebitis Inflammation of the vein, called phlebitis, occurs if the tissue or blood vessel near the PICC gets irritated or damaged. This happens in response to a foreign substance in the body (the catheter) or to the medicine or fluids being administered through the PICC. Notify your doctor or nurse if you have redness, swelling, pain, hardness or warmth near the CVAD.
Culture of PICC Tip - Question Presented
Recently a vascular access team member sent us the following question:

Q. Do you culture the tip of a PICC in a patient who has (a) a suspected infection or (b) a patient who has positive blood cultures?

A. Answer provided by Nancy Moureau, BSN, RN, CRNI. CPUI, VA-BC - The purpose of culturing the tip of the catheter is to determine whether or not the catheter is infected. This practice has mixed ratings mainly because of the varying ways in which the catheter tip is rolled out and cultured, and due to the high contamination rate. The guidelines encourage blood cultures with time to positivity rather than tip culture. For blood cultures drawn on suspected patient take one set peripherally and one through the catheter both drawn within 15 minutes of each other. Time to positivity will demonstrate whether the catheter culture grows a significant amount of bacteria of a certain type prior to the peripheral culture. In this way we can see if the catheter is infected prior to removal of the catheter. If blood cultures come back positive then a tip culture can be taken, but really it is added cost that may not be necessary. Many hospitals are no longer doing any tip cultures.

I refer you to the writings of Dr. Leonard Mermel, the CDC Guidelines 2011 and the NHSN National Health and Safety Network definitions and recommendations. I hope this information is helpful to you in your practice and please continue to look up the references to back up any change in practice!
Email address entered is not in the correct format. Please try again.
Your email address is also your login id.

It must be entered in the universally recognized format of name @ domain name . domain. Example: JohnDoe@newaccount.com
Home Health FAQ - Problems with your PICC
Excessive vomiting, coughing, sneezing, hiccupping or vigorous arm movement may cause the tip (the deepest position) of your PICC to change positions within your body.

Notify your doctor or nurse if you have any pain or discomfort near your PICC or in the shoulder, jaw, ear or neck, or if you have a feeling of coldness or fullness in the area.

If you hear flushing or have pain when your PICC is used, tell your nurse or doctor. Check your PICC to make sure the section outside your body does not seem longer than usual. If it does seem longer, it may have partially come out of the vein into which it was inserted. Secure the PICC tip with a dressing and call your doctor or nurse immediately for help.
How do I access and use the Site License Manager?
The Site License Manager (SLM) is intended for use by those designated as either the Site License Manager or as a contact person for their organization's site license. These individuals may create a management account which must be done before being granted access to the SLM.

Access to the SLM may be found through the Resource Center on the top menu bar.
How do I print my course certificate?
Once you successfully passed the course test you will be able to print your certificate either directly from the course itself by clicking on the Print Certificate link, or by clicking on the Reprint Certificate link on your Account Information Screen. Note that the Reprint Certificate link will not appear unless you have successfully completed a course.

You must have access to a printer and the appropriate print drivers installed on your computer or mobile device. Most printers will provide an option to save the current print job (in this case your certificate) as a PDF (electronic) file. Saving your certificate as a PDF can save you some time by allowing you to store the pdf on your own computer and print as needed rather than having to launch a browser, login in to our site and then print from your account information screen.
How do I reset my password?
If you've forgotten your password, simply click on the Forgot Password link in the login window. Enter the email address you are currently using as your login ID to our site. An email will be sent to that address with a randomly generated password. Copy the new password from the email then paste it into the password box in the login window.

Since your new password is a randomly generate character string, when you log in click on the Edit Account Info link to change it to something easier to remember and use.
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Your login id is your email address. Please be sure you are using the one selected for your PICC Excellence account.

If your password is incorrect, type it in again slowly and exactly as you created it, being certain not to press the caps key or the space bar.

Contact us at (888) 714-1951 if you continue to have problems, we are happy to look up your email or correct your password for you.
What is a PICC?
Peripherally inserted central catheters (PICCs) are venous access devices used to administer all types of intravenous medications and solutions.

PICCs are soft, flexible catheters about the size of a piece of spaghetti. They are inserted by specially trained nurses, physicians, physician assistants, nurse practitioners or radiological technologists.

PICCs are used in all care centers and allow patients to have one access device for the full length of therapy. The popularity of PICCs has increased due to the ease of insertion through the veins of the arm, the low risk associated with them and the low cost of insertion. As with all central lines, PICCs require x-ray confirmation immediately after placement and prior to administration of medication. Successful terminal tip location is the distal portion of the superior vena cava.
What is the best training path for learning to insert PICCs?
PICC Excellence, Inc. offers Workshops in Adult and Pediatric PICC Insertion. Each Workshop registration includes the Beginner Insertion Bundle online and one and a half days + of classroom training with instructors.

If you are unable to attend the Workshop, you may purchase the Beginner Insertion Bundle and do the online education in the privacy of your own home. This bundle includes our marque product Basic PICC Qualification Training followed by 3 short programs using ultrasound for venous access. For more information and to register for the Workshop or purchase online education click here.
Why Would I Receive a PICC?
PICCs can be used for just about any therapy. This type of catheter comes in single, double or triple lumen (channel) designs.

Like all catheters, no matter how many lumens, there is still only one entrance site (the place where the PICC is actually inserted into your vein) and exit site (the place where it comes out of your skin). The PICC exits the skin near the vein in which it is placed. On the outside of your skin is a small segment of the catheter covered with a cap. This is where your medications are infused into the catheter. Compared with other vascular access devices, PICCs are quick and easy to place as there is no tunnel or surgical pocket to create. No incision is required for a PICC, only a puncture into the vein. In addition, PICCs may have fewer complications than other devices.

Although most people need PICCs for only a few weeks or months, PICCs can last for years if taken care of properly. They are relatively small and flexible, so most people find them comfortable. However, because there is an external segment, all PICCs require regular flushing and dressing changes.

Your doctor or healthcare provider will give you specific instructions about care, maintenance and any activity limitations. PICCs usually do not require any special procedure for removal. They slide out like a regular Intravenous (IV) catheter. A nurse can remove them in your doctors office or at home.
Your Site License individual account has been deactivated.
Your site license account has been deactivated for several possible reasons.
  • You are no longer employed with the organization that owns the site license.
  • Through inactivity your site license slot was re-allocated to another individual on your IV team.
  • The site license has expired.
Contact PICC Excellence, Inc. at (888) 714-1951 to have your site license account converted to a private account. This will give you access to your completed classes and certificates.