From the Guidelines
Removal of a Peripherally Inserted Central Catheter (PICC) line is not always necessary in cases of bacteremia when the source of infection is not the PICC line.
Key Considerations
- The decision to remove a PICC line in a patient with bacteremia should be individualized based on the organism and clinical circumstances 1.
- In cases where the PICC line is not the source of infection, removal may not be necessary, especially if the line is still needed for treatment 1.
- However, if the patient has a complicated infection, such as endocarditis or osteomyelitis, or if the bacteremia is persistent despite appropriate antimicrobial therapy, removal of the PICC line may be necessary 1.
Organism-Specific Considerations
- For coagulase-negative Staphylococcus (CNS) infections, an attempt to preserve the catheter can be made if the patient is stable 1.
- For Staphylococcus aureus infections, the literature is divided, but removal of the line is often recommended to prevent metastatic spread 1.
Clinical Circumstances
- The presence of a tunnel infection, pocket infection, or persistent bacteremia despite adequate treatment are indications for removal of the PICC line 1.
- The decision to remove a PICC line should be based on clinical judgement and illness severity, taking into account the potential risks and benefits of removal 1.
- In general, the approach to removal of a central catheter in a patient with bacteremia and a clear alternative focus should be individualized, and removal is not always necessary if the line is still needed and the infection is being adequately treated 1.
From the Research
Removal of Peripherally Inserted Central Catheter (PICC) Line in Cases of Bacteremia
- The necessity of removing a PICC line in cases of bacteremia when the source of infection is not the PICC line is a complex issue, with varying opinions and practices among healthcare professionals 2, 3.
- A study published in 2001 found that in neonates, the outcome for patients in whom the central catheter was not removed within 24 hours of organism identification was significantly worse than it was for those whose catheters were removed promptly 3.
- However, another study published in 2010 found that in the presence of active surveillance and intervention to remove unnecessary or high-risk central venous catheters, central venous catheters and PICCs had similar rates of central line-associated bloodstream infections (CLABSIs) 2.
- A more recent study published in 2020 found that patients with PICC-line associated bacteremia had a significant excess mortality, with a 30-day mortality rate of 22.09% compared to 11.83% in the control group 4.
- It is worth noting that the decision to remove a PICC line in cases of bacteremia should be made on a case-by-case basis, taking into account the individual patient's condition, the source of the infection, and the risk of complications 5, 6.
- The importance of proper nursing interventions, including pre-procedure, during the procedure, post-procedure, maintenance, and team management interventions, cannot be overstated in preventing PICC-related complications 5.
Key Considerations
- The source of the infection should be identified and treated promptly 3.
- The risk of complications, including infection-related complications, should be carefully assessed 6.
- The decision to remove a PICC line should be made in consultation with a senior doctor, taking into account the benefit/risk ratio 4.
- Proper nursing interventions and care are crucial in preventing PICC-related complications and ensuring patient safety 5.
Bacteremia and PICC Lines
- Bacteremia on PICC lines remains an important public health issue, with a prevalence of 2.27% in one study 4.
- The correlation analysis shows that the unit profile explains 72% of the variability in the rate of bacteremia, highlighting the importance of proper infection control measures 4.
- Early bacteremia, occurring within 21 days of insertion, represented 75% of cases in one study, emphasizing the need for close monitoring and prompt treatment 4.