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I have been placing and teaching RN's to place PICCs for ten years. I have two thoughts on trimming PICCs. First, I have never trimmed a PICC line. PICC lines are manufactured with a smooth rounded ending point for a reason; trimming the lines produces a jagged end point and may lead to thrombus formation. Also, some lines are reverse tapered and when they are trimmed the widest part of the catheter is in the smallest part of the vein when it is hubbed or within several centimeters (not sure of the exact number, sorry). So, for the original poster of this thread - if the catheter you use is reverse tapered, trimming to the exact length may be leading to thrombus formation in the upper arm. Just a thought to consider. Second, I know the manufacturers of PICC lines have the capability to produce different length catheters but many choose not to. Have had many conversations with one company and was told that we just needed to trim out PICCs like everyone else. Recently changed manufacturers and have had three visits from the previous manufacturer (we place a lot of PICCs in multiple locations). Why did we change? Several reasons, one being they only make one length. Why didn't we tell them? We did, multiple times. They didn't listen. Now they are listening. We now have three catheter lengths with the new manufacturer to choose from and we will continue to not trim our PICC lines for the benefit of our patients. Just some food for thought. I am sure trimming catheters will continue indefinitely but consider leaving several cm's exposed if the catheter you use is reverse tapered and if you trim, use the best device (I believe that would be the guillotine) to ensure the cleanest cut. Please read: J Infus Nurs. 2014 Nov-Dec;37(6):466-72. Cutting peripherally inserted central catheters may lead to increased rates of catheter-related deep vein thrombosis.

Great - thanks alot I will check into what we are using. Do not think it is one of the ones you mentioned. Seems like we have too many occlusions lately even 1 to 2 days after picc insertion. Using too much cathflo if you ask me. Beginning to think some of this could be avoided if we inservice the staff on the correct flushing techique with a positive pressure valve. Have a good day and thanks again.

iluvivt - you asked what brand and name of ns are we using? why is that? thanks

If you ever golfed, it is like lining up your tee shot. No kidding. If you line yourself up correctly and go right at it, you are dead center 99% of the time. : )

We are having the same debate at our facility and looking at our policy. Currently our policy states to use cathflo for occlusions. The question has come up - if you have multiple lumens, they all flush easily but cannot get blood return from one lumen, do you TPA it? No other problems, not sluggish, not leaking at insertion site, tip placement is correct from recent cxr, dressing and valves have been changed so no issue there. Technically not an "occlusion" plus throw into the picture that the patient is being discharged in the next day or two. Do you charge the pt to TPA a line that is being removed very soon? I understand the retrograde flow and risk of infection but does anyone know of supporting data to ALWAYS TPA a line that does not have blood return but flushes easily and has another working lumen? I am trying to look at all the data so that I can accurately present a recommendation that has supporting data either way. Thanks