Central line or PICC line insertion
A thin, soft tube placed into a large vein near the heart so medicines, fluids, chemotherapy, feeding or repeated blood tests can be given without needing a fresh drip each time.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A central line or PICC gives reliable access to a large vein so treatment such as chemotherapy, antibiotics or feeding can be given without repeated needles.
- It is put in through a small skin puncture under ultrasound and X-ray guidance with local anaesthetic — not a big operation, but the tip sits near the heart.
- The two main risks are infection (in the line or bloodstream) and a blood clot in the vein; good daily care and clean technique lower these risks.
- The line should stay only as long as you need it, and should be removed once treatment finishes or if it causes problems.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your radiologist will give you advice for your situation.
Reliable access to a large vein for treatment that could damage smaller arm veins
There is active infection in the bloodstream or at the planned entry site that should be treated first.
Mild soreness or bruising at the site is normal. If a neck or chest vein was used, staff may watch you for a short time and check a chest X-ray before the...
Clear written instructions on flushing and dressing changes, and who will do them.
Mild soreness or bruising at the site is normal. If a neck or chest vein was used, staff may watch you for a short...
Keep the dressing clean and dry. Some aching along the arm or neck can occur. The line can usually be used for...
A district nurse or you will change the dressing and flush the line as instructed. The skin entry point should...
Regular flushing and dressing changes continue. Watch daily for redness, swelling, pain, discharge, fever or arm...
What is a central line or PICC line?
A central venous line is a thin, soft tube (catheter) placed into one of the large veins that lead back to the heart. A PICC is one common type: it goes in through a vein in the upper arm and threads up so its tip sits in a big vein near the heart. Other central lines go in through a vein in the neck or upper chest.
The line is used so that medicines, fluids, chemotherapy, intravenous feeding or repeated blood tests can be given over days, weeks or months without putting a new needle in each time. Some drugs are too strong for small arm veins and must go into a large central vein.
It is usually put in by an interventional radiologist, a specialist nurse or an anaesthetist, using an ultrasound scan to see the vein and an X-ray to check the tip is in the right place. The skin is numbed with local anaesthetic, and a needle is used to enter the vein — there is a small puncture, not a large surgical cut. A tunnelled line or a port (a different device under the skin) may be suggested if you need access for many months.
A line makes treatment easier and more comfortable, but it is a tube that goes inside a vein, so it carries real risks of infection and clotting and needs careful looking after.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
PICC line versus an implanted chest port
| Feature | PICC line | Chest port |
|---|---|---|
| Where it sits | Partly outside the upper arm | Fully under the skin of the chest |
| Daily care | Needs regular dressing changes and flushing | Less daily care; accessed with a needle when used |
| Best for | Weeks to a few months | Months to years, intermittent treatment |
| Bathing/swimming | Must keep dry and covered | Can usually shower and swim when not in use |
Your team will recommend the type that fits your treatment, your veins and how long you need access. Ask why a particular line is being suggested for you.
Preparing for your procedure
- Tell the team about any allergies, bleeding problems, or blood-thinning medicines (such as warfarin, apixaban or clopidogrel), as these may need adjusting first.
- You may have a blood test to check your clotting and blood count before the line goes in.
- Mention any previous lines, clots, narrowed veins, or a pacemaker, and which arm or side has been used before.
- If sedation is planned, you may be asked not to eat for a few hours and to arrange someone to take you home.
- Wear loose clothing with sleeves that roll up easily, especially for a PICC.
- Ask who will look after the line at home, and whether a district nurse or you will do the dressings and flushing.
- Tell the team if you have an infection anywhere (such as a cold, urine or skin infection), as it may be safer to wait.
What happens
You lie on a couch in the X-ray or treatment room. For a PICC, the team uses an ultrasound scan to find a suitable vein in your upper arm; for a neck or chest line, they scan that area. The skin is cleaned thoroughly and numbed with local anaesthetic.
A needle is used to enter the vein through a small puncture, and the soft tube is threaded gently into position. X-ray pictures (or sometimes a tracing of the heart rhythm) are used to check the tip is in the right place, in a large vein just above the heart. There is usually little pain once the area is numb, though you may feel pushing or pressure.
The line is secured to the skin with a fixing device, a stitch or a dressing, and a clean dressing is applied. The whole procedure usually takes around 30 to 60 minutes. Afterwards the position may be confirmed on a chest X-ray before the line is used. Staff will show you, or your nurse, how to keep it clean and how to spot problems.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- There is active infection in the bloodstream or at the planned entry site that should be treated first.
- The target veins are blocked, badly narrowed or previously damaged, so another route or device is needed.
- A bleeding tendency or blood-thinning medicine cannot be safely managed around the procedure.
- A simple short course of treatment could be given safely through an ordinary arm drip instead.
Delay or rearrange if…
- You have a current infection (such as a chest, urine or skin infection) or unexplained fever.
- Your blood-clotting results or platelet count are outside safe limits and can be corrected.
- Blood-thinning medicines have not yet been adjusted as advised.
- There is no clear plan yet for who will care for the line at home.
Alternatives to discuss
- An ordinary peripheral cannula (arm drip) for short courses of treatment.
- An implanted chest port for long-term, intermittent access such as repeated chemotherapy.
- A tunnelled line if access is needed for many months.
- Changing the treatment plan (for example oral medicines) where clinically appropriate.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Reliable access to a large vein for treatment that could damage smaller arm veins
- Avoids repeated needles for drips and many blood tests
- Lets chemotherapy, long antibiotic courses, fluids or feeding be given safely over time
- Can often be used at home, with support, rather than staying in hospital
- Can be removed easily when treatment is finished
Risks & complications
- Bruising, soreness or a small amount of bleeding at the puncture site
- Discomfort or tightness in the arm or neck for a day or two
- The dressing needing regular changes, and keeping the site dry
- The line occasionally becoming blocked and needing flushing or unblocking
- Infection at the skin entry site, needing antibiotics
- A blood clot (thrombosis) in the vein the line sits in
- The line tip moving out of position, or the line slipping out
- Irritation of the vein causing aching along its path
- A bloodstream infection (line-related sepsis), which can be serious and usually means removing the line
- Air entering the vein, or a small collapse of the lung (pneumothorax) when a neck or chest vein is used
- Damage to a nearby artery or nerve during insertion
- An irregular heartbeat while the tip is positioned, which usually settles
The two risks that matter most over time are infection (in the skin, the line or the bloodstream) and a clot in the vein. The chance of a clot is higher in people having chemotherapy. Good hand hygiene, clean technique at every dressing and flush, and removing the line as soon as it is no longer needed all lower the risk. Ask your team exactly who to contact, day or night, if you develop a temperature or the area becomes red or painful.
Published figures to discuss
Risk depends on the type of line, how long it stays in, and your underlying illness and treatment. The two most important risks — infection and clot — rise the longer a line is in place and are higher in people having chemotherapy. Figures below are drawn from NHS patient information and should be discussed in the context of your own situation rather than treated as exact.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Blood clot (thrombosis) in the vein with a PICC during chemotherapy | Reported around 2–6 in 100 in NHS patient information | Higher in people having chemotherapy; the line can often stay in while the clot is treated. | NHS (Guy's and St Thomas') — PICC lineguysandstthomas.nhs.ukSource-linked context |
| Line infection | Uncommon but clinically important; risk rises with duration and handling | Fever, rigors during flushing, redness or discharge at the line site needs urgent advice. | NHS (Guy's and St Thomas') — PICC lineguysandstthomas.nhs.ukSource-linked context |
| Line blockage, malposition or accidental removal | Common enough to be part of routine line care | Flushing technique, secure dressings and prompt review of poor flow reduce treatment delays. | Guide sourcesClinical context |
| Pneumothorax with some central venous access routes | Rare with ultrasound guidance, not expected with arm PICC placement | Chest pain or breathlessness after neck or chest line insertion needs urgent review. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is very little physical recovery from putting the line in itself. The bigger task is looking after the line safely for as long as it stays in, and knowing the warning signs of infection or a clot.
- Mild bruising, soreness or a small lump at the puncture site for a few days
- Slight aching along the vein in the first day or two
- A clean, dry skin entry point that does not get more red or sore over time
- Needing help from a nurse, or learning yourself, to flush and re-dress the line
Aftercare
- Keep the dressing clean, dry and intact; cover it well for showering and do not let a PICC get wet.
- Attend or arrange regular dressing changes and line flushes exactly as advised, even if the line is not being used.
- Wash your hands, and ask anyone handling the line to wash theirs, before touching it.
- Do not let the line be used for blood tests or extra treatment unless staff are trained in caring for it.
- Avoid heavy lifting or vigorous arm exercise on the PICC side if advised.
- Keep the clinic or ward's contact number with you, and know who to call out of hours.
- Keep a record of when the line was put in and when it is due to be reviewed or removed.
- Written instructions on flushing and dressing changes
- A 24-hour contact number for the team
- Spare clean dressings or a waterproof cover for showering
- A clear plan for who does the dressings (you, a carer or a district nurse)
- Knowing the warning signs of infection and clot
- The date the line was inserted and a planned review/removal date
Scars and how they heal
There is no large surgical scar. A PICC enters through a small puncture in the upper arm, and a tunnelled chest line has one or two small skin punctures or short cuts that usually heal to leave a small mark. Once any line is removed, the entry point closes over and typically fades to a tiny scar or none at all.
⚠ Get urgent help if…
- A temperature, fever, shivering or feeling suddenly unwell — this can mean a line infection and needs urgent assessment
- Increasing redness, swelling, heat, pain or discharge at the entry site
- Swelling, pain or colour change in the arm, neck or face on the side of the line (possible clot)
- Sudden breathlessness or chest pain — call 999
- The line falling out, being pulled, leaking, or appearing longer than before
- The line will not flush, or fluid leaks around it when used
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your radiologist gives you.
Results & realistic expectations
A well-placed line gives dependable access to a large vein so your treatment can be given safely and comfortably for as long as you need it. Its position is confirmed before it is used. A line does not treat the underlying condition itself — it is a route for treatment — and it works best when it is looked after carefully and removed once it is no longer needed.
How long a line stays in depends on the type and your treatment. A PICC may last weeks to a few months; a tunnelled line or port can stay for many months if cared for well. Lines can be removed and, if necessary, replaced. The longer any line stays in, the more the small daily risks of infection and clot add up, so your team will review regularly whether it is still needed.
Related tests, treatments or support
A line is often placed as part of a wider treatment plan, such as chemotherapy, a long course of intravenous antibiotics, or intravenous feeding. If you are likely to need access for many months, your team may discuss a tunnelled line or an implanted chest port instead, which can be more convenient and may carry a lower infection risk.
Follow-up & long-term care
Your line will be flushed and re-dressed on a set schedule by a nurse or by you, and the entry site will be checked each time. The team will review whether the line is still needed and arrange its removal at the right time. Report any fever, redness or arm swelling straight away rather than waiting for the next appointment.
- Regular flushing to keep the line from blocking, even between treatments
- Routine dressing changes using clean technique
- Periodic review of whether the line is still needed
- Prompt removal once treatment is finished or if problems develop
Repeat, follow-on and what comes next
- A line can block and need flushing, unblocking, or occasionally replacing.
- If the tip is out of position, the line may need adjusting or re-siting.
- A line-related infection or clot may mean the line has to be removed and, if still needed, replaced.
- Long-term access often moves to a tunnelled line or port if treatment continues for many months.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written instructions on flushing and dressing changes, and who will do them.
- A named 24-hour contact route for fever, redness, swelling or a line that will not flush.
- Regular review of whether the line is still needed, with prompt removal when it is not.
- Staff trained specifically in caring for and using the line, and clean technique every time.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The type of line (PICC, non-tunnelled, tunnelled) and the number of lumens
- Operator and team fees, and the use of an imaging room with ultrasound and X-ray
- Whether light sedation is used
- Confirmatory imaging such as a chest X-ray
- Ongoing care: dressings, flushes and district-nurse or clinic visits while the line is in
- Removal of the line and management of any complications
- The operator and facility fees for placing the line
- Imaging used to guide and confirm placement
- Any sedation and its monitoring
- Who provides ongoing dressing changes and flushes, and at what cost
- The cost of removing the line at the end of treatment
- What happens, and who pays, if a complication such as infection or clot occurs
On the NHS? Central lines and PICCs are routinely placed on the NHS as part of treatment such as chemotherapy or long courses of intravenous antibiotics; private placement is mainly for speed, choice or where care is being given privately.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not explaining that the tip sits near the heart and that infection or clot are real risks.
- No clear plan or contact route for daily care, dressings and flushes at home.
- No agreed plan or date to review and remove the line once treatment ends.
- Assuming any nurse can use the line, when specific training is needed to use and care for it safely.
Marketing red flags
- Describing line insertion as completely without risks or trivial.
- Not mentioning infection, clot or the need for ongoing care.
- Offering a line without a clear treatment reason or removal plan.
- No 24-hour contact arrangement for problems after insertion.
Choosing a specialist safely
- Check the radiologist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the radiologist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good radiologist will welcome every one of these.
- Which type of line do you recommend for me, and why that one for my treatment?
- How long do you expect the line to stay in, and when will it be reviewed for removal?
- Who will do my dressings and flushes — me, a carer, or a district nurse?
- Exactly who do I contact, day or night, if I get a temperature or the area becomes red or painful?
- What is my personal risk of a clot, especially if I am having chemotherapy?
- What should I do for bathing, swimming and exercise while the line is in?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the radiologist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does it hurt to have the line put in?
Can I shower or bath with a PICC line?
How long can the line stay in?
What if I get a temperature?
Is having the line removed difficult?
Will I be able to use my arm normally?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS (Guy's and St Thomas') — PICC line NHS (UCLH) — Peripherally inserted central catheters (PICCs) NHS (Cambridge University Hospitals) — Care of your PICC BSIR — What is interventional radiology? NHS (Gloucestershire Hospitals) — PICC procedure and care
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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