PICC lines

Editorial Team / Admin · Nov 5, 2015

From the Infusion Nurses Society:

Q: A patient has had a PICC in place for two years without complications and continues on therapy for anundetermined period of time. How long can a PICC remain in place under these circumstances?
A: The maximum dwell time for a PICC is not known.

The quote comes from this page, which includes a bibliography.

Courtney Nurse Writer, BSN · Nov 5, 2015

Hmm. That helps a lot, thank you! The physician who is treating a patient had said he's known people with PICC lines for many years and I just thought the max time was 1 year.

iluvivt, BSN, RN · Nov 6, 2015

Ii is true there is no definite max dwell time. I must state through if is is a silicone PICC it is a good idea to change it.The silicone gets fairly frail I took one out that had been in for four years and it was so thin and limp and I could tell it had deteriorated. The polyurethane is a bit sturdier. I prefer to change them about after about a year unless they are almost through their therapy.

Courtney Nurse Writer, BSN · Nov 6, 2015

Ok thank you for the info. The one I have seen had white exudate and the area around the insertion site was very red and almost look like cellulitis had developed though was soft and the patient denied any pain. The catheter itself does not give blood return but flushes easily. The nurse caring for this line said that was all perfectly normal and changed the dressing and sent the patient on his way. Too me, that was not an Ok site but I do not have much experience with PICC lines. Also of note he is getting IV therapy which includes antibiotics at home.

IVRUS, BSN, RN · Nov 10, 2015

Ok thank you for the info. The one I have seen had white exudate and the area around the insertion site was very red and almost look like cellulitis had developed though was soft and the patient denied any pain. The catheter itself does not give blood return but flushes easily. The nurse caring for this line said that was all perfectly normal and changed the dressing and sent the patient on his way. Too me, that was not an Ok site but I do not have much experience with PICC lines. Also of note he is getting IV therapy which includes antibiotics at home.

Good for you for recognizing that being able to flush, but NOT obtaining a blood return is NOT OKAY.

One MUST get a brisk, free flowing blood return from all Central IV catheters, including PICC's.

iluvivt, BSN, RN · Nov 12, 2015

The PICC line you describe had a few issues that needed to be addressed. It has a persistent withdrawal occlusion, in that you can instill easily but not withdraw and it should be treated with 2 mg of Tpa (Cath-flo) to restore a blood return. It should not have any drainage if that is what you mean by a white exudate. They usually only ooze for a few days after placed or if the patient is quite anticoagulated or has a lot of edema. Home care patients must be instructed on how to bathe and shower and keep their PICC site bone dry. If they get them wet and let them air dry sometimes you will see whitish skin or an irritation around the insertion site especially if the biopatch got wet. You need to ask the patient a few questions to make sure they are doing this correctly. I also would have assessed for s/sx of infection, including checking on the patient's WBC count and may have requested a CBC,but I would need to see what you saw to tell for sure what I would do of course!