How long can a Peripherally Inserted Central Catheter (PICC) line be placed?

Duration Guidelines for PICC Line Placement

PICC lines should be used for 15 or more days for peripherally compatible infusates, while shorter durations (≤5 days) should use peripheral IV catheters instead. 1

Appropriate Duration Based on Infusate Type

For Peripherally Compatible Infusates:

• ≤5 days: PICC use is inappropriate; use peripheral IV or ultrasound-guided peripheral IV instead 1
• 6-14 days: PICC use is appropriate but midline catheters and ultrasound-guided peripheral IVs are preferred 1
• ≥15 days: PICCs are preferred over midline catheters 1
• ≥31 days: Consider tunneled catheters or implanted ports for long-term access 1

For Non-Peripherally Compatible Infusates (Irritants/Vesicants):

• PICC use is appropriate at any duration 1
• ≤14 days: Non-tunneled central venous catheters can be used if skilled operators are available 1
• ≥15 days: Tunneled, cuffed catheters are appropriate 1
• ≥31 days: Implanted ports are appropriate 1

Special Population Considerations

Critically Ill Patients:

• ≤14 days: Central venous catheters preferred for hemodynamically unstable patients 1
• ≥15 days: PICCs are appropriate 1
• For coagulopathies (e.g., DIC or sepsis), PICCs are preferred over CVCs, especially for longer durations 1

Cancer Patients:

• ≤14 days: Midline catheters preferred for frequent phlebotomy or difficult access 1
• ≥15 days: PICCs appropriate 1
• ≥3 months: Tunneled catheters preferred 1
• ≥6 months: Implanted ports appropriate 1

Chronic Kidney Disease (CKD):

• For CKD stage 3b or greater (eGFR <45 mL/min): Avoid PICCs to preserve veins for potential hemodialysis access 2
• Consider tunneled small-bore central catheters for longer durations 2

Complications Associated with Duration

Short-term PICC use (≤5 days) is associated with complications including:

• Venous thromboembolism (2.5%)
• Central line-associated bloodstream infections (0.4%)
• Catheter occlusion (4%)
• Tip migration (2.2%) 3

Long-term PICC use has shown:

• Increased risk of complications after 30 days of placement 4
• Overall complication rate of 4.66 per 1,000 catheter days 4
• In post-stem cell transplant patients, median duration of 67 days with 27% experiencing complications 5

Practical Considerations for PICC Maintenance

• Monitor for signs of complications including infection, thrombosis, occlusion, and displacement 6
• Patient education before discharge is essential to prevent delayed care for complications 6
• For long-term use, proper catheter tip location in the superior vena cava or right atrium may decrease complication risk 4

Common Pitfalls to Avoid

1. Using PICCs for short-term access (≤5 days) when peripheral options are available
2. Failing to select the appropriate device based on expected duration of therapy
3. Not considering patient-specific factors (kidney disease, frequent hospitalizations)
4. Using multilumen devices when single lumen would suffice (associated with higher complication rates) 1, 3
5. Placing PICCs in patients with difficult venous access without considering duration of use 3

Remember that device selection should be based on patient diagnosis, clinical status, type/frequency/duration of therapy, history of venous access, and operator experience 1.