PIV in same arm as PICC removal

[csherriff]

I am looking for any evidence or articles regarding a wait time prior to insertion of a PIV in an arm where a PICC line has been removed. We place all of our PICC lines in the upper arm, so the PIV would be started below the original PICC site.

I have not been able to find any information to guide us in a policy for how soon after a PICC removal a PIV can be placed. I would appreciate any replies that could lead me to some information. I have done a literature search and contacted the manufacturer of the PICC lines that we use, to no avail.

Thanks for any assistance you can provide.

Colleen

[iluvivt, BSN, RN]

There is no current recommendation or standard of care that states you need to wait X amount of time before starting a PIV below a newly discontinued PICC line. However,you must be prudent and make this decision on a case by case basis and weigh the benefit vs the risk to the patient. In some situations you would want to avoid the lower arm right after a PICC has been discontinued above a potential PIV site. For example,if you are discontinuing a PICC b/c of UEDVT (upper extremity deep vein thrombosis) you would optimally choose the other arm until resolved. I have often selected a PIV site below a discontinued PICC site. I will usually choose part f the cephalic vein as in the majority of cases we use the basilic and brachial veins for PICC insertion. You should also be careful if you plan to administer a vesicant chemotherapy or a medication or IV solution that if extravasates could cause tissue damage. You do not want to select a vein below that leads inot the previous PICC site b/c it may not be completely sealed and could leak out at the previous PICC site. I have seen this happen many timesd with PIVs.