Most PICCs are designed with suture wings, so the PICC can be sutured to the patient's skin. However, patients have reported long‐term suturing to be uncomfortable; there may also be scarring when the device is removed (Gabriel [159], [160]) and inflammation and bacterial colonization of the exit site (Schears [402]). Therefore, suturing is no longer recommended (Maki [289]). PICCs can be adequately secured using Steri‐Strips, securement devices (such as self‐adhesive stabilization devices applied to the skin, e.g. StatLock) or anchoring devices (such as SecurAcath) (Figure 17.31). These have been shown to result in significantly longer catheter dwell times and fewer total complications (Gabriel [160], Hughes [219], Maki [289], Schears [402], Yamamoto et al. [478]). NICE ([353]) recommends the use of SecurAcath. Bleeding occurs in the first 24 hours so a fold of sterile gauze should be placed over the site under the dressing (Philpot and Griffiths [373]). Alternatively, an absorbent pad (impregnated with CHG or silver alginate) can be used (Hill et al. [211], McGoldrick [305]). The insertion site is then covered with a semi‐permeable transparent IV film dressing (Gorski et al. [181], Loveday et al. [278], RCN [381]).

The position of the tip of the PICC should be verified immediately after insertion before any infusion. This can be done during insertion using ECG tip position technology (La Greca [256], NICE [353], Oliver and Jones [365], Pittiruti et al. [375]) or by a chest X‐ray post‐procedure. Ascertaining correct placement is the major reason for ordering a chest X‐ray, but a chest X‐ray also rules out malposition and confirms acceptable tip location for the type of medication being administered (Dougherty [123], Gorski et al. [181], RCN [381], Royer [390], Wise et al. [474]). Tip malposition can be avoided by using navigating methods or tip location technology (e.g. Sherlock or Navigator), which enables tracking of the PICC during insertion to identify malposition (La Greca [256], Naylor [345]). If using the ECG method to ascertain tip location, the print‐out and relevant information must be documented.

If the initial dressing consists of sterile gauze, it should be changed after 24 hours and then according to the dressing manufacturer's recommendations, for example once a week, to minimize the potential for infection and catheter migration (Loveday et al. [278], NICE [350], RCN [381]). If a CHG‐impregnated patch or ionic silver alginate pad is in situ following insertion, there is no need to change the initial dressing after 24 hours (Corley et al. [88], RCN [381]).

Flushing solution and frequency are usually dependent on the type of catheter and so the manufacturer's recommendations should be followed. For example, PICCs are usually flushed once a week with 0.9% sodium chloride (Gorski et al. [181], Loveday et al. [278], RCN [381]). Care should be taken when using devices such as power injectors to administer intravenous contrast agents via a PICC as the pressure created may lead to catheter rupture. The likelihood of rupture will depend on the Fr and material of the catheter (de Lutio [109], Williamson and McKinney [473]) but most manufacturers now provide CT‐compatible PICCs, made specifically to withstand the pressure created during CT scanning. The Medicines and Healthcare products Regulatory Agency recommends that CT contrast using a pressure injector should not be performed via any CVAD that is not CT rated (MHRA [312]).

The following should be documented on insertion (Chopra et al. [77], Gorski et al. [181], Moureau and Gabriel [333], RCN [381]):

See ‘Discharging patients home with a VAD in situ’ above.