Preparing for PICC Line Placement: What to Expect

Having a PICC line placed is a minimally invasive procedure — not surgery, but more than a routine blood draw. Understanding exactly what will happen helps reduce anxiety, allows you to prepare practically, and helps the procedure go smoothly for both you and your vascular access nurse.

Before Your Appointment

What to wear

Wear a short-sleeved or loose-sleeved shirt. PICC placement requires access to your upper arm; a tight or long-sleeved top may need to be removed or cut. A button-up shirt or a top with wide arm openings is ideal. You will be asked to expose the arm from the shoulder down.

Medications

In most cases, you do not need to change your medications before a bedside PICC placement. However:

Blood thinners (anticoagulants): Tell your team if you take warfarin, apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), enoxaparin (Lovenox), or similar medications. These usually do not require holding for a PICC, but your team should be aware.
Aspirin and NSAIDs (ibuprofen, naproxen): Generally not a significant concern for PICC placement.
Ask your care team if you have any concern about a specific medication.

Eating and drinking

PICC placement at the bedside or in a clinic does not require fasting. You may eat and drink normally unless otherwise instructed. (Port placement under sedation is different — see the port placement guide.)

Allergies

Confirm that your allergy list is up to date. Specifically tell your nurse about any history of:

Chlorhexidine (CHG) sensitivity or allergy
Latex allergy
Tape or adhesive reactions
Local anesthetic reactions (lidocaine)

Anxiety

If you are anxious about the procedure, tell your nurse before it begins. This is common and there is no judgment. Your nurse can:

Take extra time to explain each step before doing it
Pause at any point for you to collect yourself
Offer additional support and reassurance
Arrange for a support person to be with you in some settings

The Procedure: Step by Step

PICC placement is performed at the bedside or in a procedure room by a specially trained vascular access nurse. It typically takes 30–60 minutes, including setup, placement, and confirmation.

Setting up the sterile field

Your nurse will set up a sterile work area — a large drape covering most of the bed and your body. You will be asked to lie still and avoid touching the drape once it is in place. Your nurse will be wearing a sterile gown, gloves, hat, and mask. This is called maximum barrier precautions and is standard infection prevention for central catheter placement.

Positioning

You will lie on your back with your arm extended at about a 90-degree angle from your body. A tourniquet may be applied to your upper arm briefly to help visualize veins.

Ultrasound vein selection

Your nurse uses an ultrasound probe to examine the veins in your upper arm in real time. You will see (or feel) the probe moving gently along your arm — this is painless. The nurse selects the best vein based on size, depth, and whether it is compressible (which tells the nurse it is a vein and not an artery).

Skin cleaning

The skin on your upper arm is thoroughly cleaned with chlorhexidine gluconate solution, applied in a scrubbing motion and allowed to dry completely. This feels cold and wet. The dried antiseptic creates a zone around the insertion site.

Local anesthetic

A small amount of lidocaine (local anesthetic) is injected under the skin to numb the insertion area. This injection is the most uncomfortable part of the procedure — a brief, sharp sting followed by a burning sensation that lasts 20–30 seconds, then fades as the numbness sets in. After this, you should feel pressure and movement but not significant pain.

Tell your nurse if you continue to feel sharp pain after the local anesthetic — more can be given.

Vein access

Using ultrasound guidance in real time, your nurse inserts a small needle into the selected vein. You may feel pressure. In some cases the nurse may need to make one or two attempts before successfully accessing the vein — this is normal with challenging anatomy. If you feel sharp pain at any point, say so.

Threading the catheter

A guide wire is passed through the needle into the vein; the needle is removed; the PICC catheter is threaded over the guide wire and advanced through the venous system. You will feel nothing during this step — the catheter is being threaded through your veins in the arm and chest, but there are no pain receptors inside the veins.

During this step, you may be asked to:

Turn your head toward the arm being accessed (to close off the neck vein and direct the catheter toward the heart rather than up into the neck)
Take a deep breath and hold it briefly at a specific moment

Follow your nurse’s instructions exactly — these are positioning maneuvers that help guide the catheter to the correct position.

Confirmation of position

The PICC tip must be confirmed to be in the correct position (in the superior vena cava, the large vein above the heart) before the line is used. Confirmation is typically done by:

Intracavitary ECG (IC-ECG): A technology that uses a small electrode in the catheter tip to detect the electrical signal of the heart, confirming the tip is at the correct anatomical landmark. Most vascular access teams use this today. No X-ray is needed in many cases.
Chest X-ray: In some settings or circumstances, an X-ray is taken after placement to confirm position.

Until position is confirmed, the PICC will not be used for infusions.

Securing the PICC

The catheter is secured to your arm using a securement device (often a small adhesive anchor called a StatLock or similar), and the insertion site is covered with a sterile transparent dressing. A chlorhexidine-impregnated disc is typically placed at the skin exit point. The external catheter connector (hub/lumen) is positioned so it can be easily accessed.

Immediately After Placement

What you can expect to feel

Mild tenderness or aching at the insertion site for 24–48 hours — normal
Bruising around the site in the first few days — normal
Mild awareness of the catheter in the arm — you may feel it when you move — normal
The dressing may feel tight or slightly uncomfortable at first

What to watch for right away

Sharp or escalating pain (not normal — report it)
Visible bleeding soaking through the dressing (normal to have a small spot; soaking is not normal)
The catheter appearing to have moved or shifted

First use

Your PICC will typically be used for infusions promptly once position has been confirmed. Your nurse will flush it with saline, confirm blood return (blood should flow back freely when the syringe is pulled back — this is a safety check), and begin or connect your prescribed infusion.

Before you leave (if an outpatient procedure)

Confirm with your nurse:

The external length of the PICC (how many cm protrude from your arm) — write it down
Your dressing change schedule
Your flush schedule
Your first home nursing visit date and contact number
Emergency contacts

Common Questions

Does it hurt? The local anesthetic injection stings briefly. After numbing takes effect, most patients report feeling pressure and movement but not pain during the procedure. Tell your nurse any time you feel sharp pain.

What if the vein is hard to find? Some patients have veins that are difficult to access — small, deep, or scarred from previous IVs or blood draws. Your vascular access nurse is experienced with challenging anatomy and uses ultrasound for every PICC insertion. In rare cases, the procedure may need to be attempted on the other arm, at a different site, or deferred to an interventional radiology suite.

Will I be awake? Yes. PICC placement is performed with local anesthetic only — you are fully awake and alert throughout. No sedation is used for routine bedside PICC placement. If you are very anxious or have severe needle phobia, discuss this with your care team before the procedure — options may be available.

How long until I can use my arm normally? Light to moderate arm use can resume immediately. Avoid heavy lifting, vigorous upper arm activity, or stretching the arm aggressively behind the back for the first 24–48 hours to allow the insertion site to stabilize.

Can someone be with me? In most bedside procedure settings, a support person can be present at your bedside (outside the sterile field) during the procedure. Ask your nurse.

This guide is for educational purposes and is not a substitute for instructions from your specific care team and facility.