Is it okay to use a Peripherally Inserted Central Catheter (PICC) line that is already in place when a patient is admitted to the hospital?

Using an Existing PICC Line in a Newly Admitted Patient

Prior to using a PICC line that is already in place when a patient is admitted to the hospital, radiographic verification of the PICC tip position is appropriate and necessary to ensure proper placement and safety. 1

Assessment Before Using an Existing PICC Line

When a patient is admitted with an existing PICC line, follow this algorithm:

1. Verify PICC tip position radiographically

   • Radiographic verification is rated as appropriate after admission to a hospital with an existing PICC 1
   • Confirm tip position is in the lower one-third of the superior vena cava, cavoatrial junction, or right atrium 1
   • If tip position is in the upper or middle one-third of the superior vena cava or right ventricle, adjustment is appropriate 1

2. Assess catheter integrity and exit site

   • Examine for signs of infection, dislodgement, or damage
   • Check for wet, loose, or soiled dressings that require immediate changing 1
   • Verify the external length marking matches documentation (if available)
   • Assess for migration of the catheter

3. Review PICC documentation

   • Date of insertion
   • Original indication for placement
   • Previous complications
   • Type of catheter (single vs. multi-lumen)

Decision Making for PICC Use

When to Use the Existing PICC:

• Proper tip position confirmed radiographically
• No signs of infection or mechanical complications
• PICC is appropriate for the current clinical indication

When NOT to Use the Existing PICC:

• Signs of catheter-related bloodstream infection
• Improper tip position requiring adjustment
• Damaged catheter or compromised integrity
• PICC-related deep vein thrombosis

Important Considerations

Lumen Selection

• Use single-lumen devices when possible to reduce complications 1
• Multi-lumen PICCs should only be used when there is a documented rationale (e.g., multiple incompatible fluids) 1
• If using a multi-lumen PICC, dedicate one lumen exclusively for parenteral nutrition if applicable 1

Dressing Management

• Place sterile gauze between the PICC entry site and adhesive dressing for the first 1-2 days of insertion 1
• Use clear, transparent dressings thereafter that permit site examination 1
• Change dressings weekly or more frequently if wet, loose, or soiled 1

Catheter Maintenance

• Use normal saline rather than heparin to maintain catheter patency 1
• Never advance a migrated PICC; guidewire exchange is appropriate if needed 1
• Remove the PICC when it has not been used for clinical purposes for 48 hours or longer 1

Special Populations

For patients receiving tumor-infiltrating lymphocyte cell therapy, a PICC line is considered appropriate for delivery of the non-myeloablative lymphodepletion regimen, infusion of TIL cells, IL-2 administration, and subsequent supportive care measures 1.

For patients requiring long-term parenteral nutrition (>3 months), tunneled catheters are generally preferable to PICCs 1.

Complications to Monitor

Be vigilant for potential complications including:

• Catheter-related bloodstream infections (2.5% in hospitalized cancer patients) 2
• Deep vein thrombosis (3.6% in hospitalized cancer patients) 2
• Catheter occlusion (10% in hospitalized cancer patients) 2
• Embolic complications from improper placement 3

Key Pitfalls to Avoid

1. Failing to verify tip position: Always confirm proper placement radiographically before use 1

2. Using a PICC with signs of infection: Remove the PICC if there are signs of catheter-related bloodstream infection 1

3. Advancing a migrated PICC: Never attempt to advance a dislodged PICC; guidewire exchange is appropriate if needed 1

4. Using multi-lumen PICCs without clear indication: Default to single-lumen devices when possible to reduce complications 1

5. Neglecting dressing care: Ensure proper dressing maintenance to prevent infection 1