Do I need to image a Peripherally Inserted Central Catheter (PICC) line placed in the hospital 2 weeks ago if the patient returns to the Emergency Department (ED) and will need more antibiotic (ABT) therapy?

Management of PICC Lines for Continued Antibiotic Therapy

Imaging is not necessary for a PICC line placed 2 weeks ago if the line is functioning properly and there are no signs of complications, especially when the patient is returning for continued antibiotic therapy. 1, 2

Assessment Algorithm for PICC Line Reuse

Step 1: Evaluate PICC Line Function and Integrity

• Check for patency (ability to flush with normal saline)
• Inspect insertion site for:
  • Signs of infection (redness, swelling, discharge, pain)
  • Catheter migration or dislodgement
  • Integrity of dressing (should be clean, dry, and intact)

Step 2: Review Documentation from Initial Placement

• Confirm proper tip position was documented at initial placement
• Verify the PICC was placed with appropriate technique (e.g., electrocardiographic guidance)
• Check that proper documentation exists from the original placement 2

Step 3: Assess for Complications

• Ask about symptoms of venous thrombosis (arm pain, swelling)
• Check for signs of infection (fever, chills)
• Evaluate for mechanical complications (catheter occlusion, damage)

Evidence-Based Rationale

The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) considers routine radiographic verification inappropriate when:

1. The PICC was placed with electrocardiographic guidance
2. Proficiency with this technology has been demonstrated
3. Adequate tracings were observed during placement
4. The line was placed at the same facility within the past 2 days with proper documentation 2

While the MAGIC guidelines specifically mention 2 days, the principle applies to longer timeframes when the catheter has been functioning properly without complications. The guideline states that a PICC that is no longer functional may be exchanged over a guidewire, provided there are no signs of infection and an indication for continued use exists 1.

Common Pitfalls to Avoid

1. Unnecessary imaging: Performing routine imaging on properly placed and documented PICCs wastes resources and exposes patients to unnecessary radiation 2

2. Improper maintenance: Use normal saline rather than heparin to maintain catheter patency 1

3. Advancing migrated PICCs: This is rated as inappropriate regardless of how far the PICC has migrated; guidewire exchange is the appropriate approach if the catheter has migrated 1

4. Delayed recognition of complications: Regular assessment of the insertion site and catheter function is essential to identify complications early 1, 3

Special Considerations

• For patients with chronic kidney disease stage 3b or greater (eGFR <45 mL/min), special consideration should be given to vein preservation 2, 4

• If the PICC line has not been used for clinical purposes for 48 hours or longer, removal may be appropriate after physician notification 1

• Clear, transparent dressings should be used to permit site examination, and dressings should be changed weekly or when wet, loose, or soiled 1, 2

By following this approach, you can safely reuse the existing PICC line for continued antibiotic therapy without unnecessary imaging, while ensuring patient safety through proper assessment and monitoring.