What are the guidelines for PICC (Peripherally Inserted Central Catheter) line care and maintenance?

PICC Line Care and Maintenance Guidelines

PICC line care should follow standardized protocols including weekly dressing changes, routine flushing with normal saline after each use, and daily site assessment to minimize complications such as infection and thrombosis. 1

Insertion Considerations

Site Selection

• Right-sided insertion is preferred over left-sided to reduce thrombosis risk 1
• Upper extremity sites are recommended for adults 1
• Avoid femoral vein insertion due to increased infection and thrombosis risk 1
• Use ultrasound guidance for insertion to reduce mechanical complications 1

Catheter Selection

• Use single-lumen PICCs unless multiple lumens are clinically necessary 1
• Select appropriate catheter based on intended purpose, duration, and known complications 1
• Consider PICCs for therapy expected to last less than 6 months 1
• For therapy exceeding 6 months, tunneled catheters or implantable ports may be preferable 2

Tip Placement

• Optimal catheter tip position is at the junction of the superior vena cava and right atrium 1
• Verify placement with fluoroscopy during insertion or post-insertion chest X-ray 1
• Electrocardiographic guidance can be used as an alternative to radiologic confirmation 1

Routine Maintenance

Dressing Care

• Use sterile transparent or gauze dressings to cover the insertion site 1
• Change transparent dressings weekly and gauze dressings every 2 days 1
• Change dressings immediately if wet, loose, or soiled 1
• Use chlorhexidine with alcohol for skin antisepsis during dressing changes 1
• Consider chlorhexidine-impregnated sponge dressings if infection rates remain high despite adherence to basic prevention measures 1

Flushing Protocol

• Use normal saline rather than heparin to maintain catheter patency 1, 2
• Flush with saline after completion of any infusion or blood sampling 1
• For PICCs not in active use, perform weekly flushes 1
• Use infusion pumps for parenteral nutrition administration 1

Site Assessment

• Evaluate the insertion site daily for signs of infection or complications 1
• Check for tenderness, erythema, swelling, or discharge 1
• Document site assessment findings regularly 1

Infection Prevention

Hand Hygiene

• Perform hand hygiene before and after all catheter-related interventions 1
• Use alcohol-based hand rubs or conventional soap and water 1

Aseptic Technique

• Use maximal sterile barrier precautions during insertion (cap, mask, sterile gown, sterile gloves, full-body drape) 1
• Wear sterile gloves for dressing changes 1
• Clean injection ports with 70% alcohol before accessing the system 1
• Cap all stopcocks when not in use 1

Staff Education

• Ensure healthcare personnel are properly trained in PICC care 1
• Designate trained personnel for insertion and maintenance 1
• Regularly evaluate knowledge and adherence to guidelines 1

Complication Management

Catheter-Related Bloodstream Infection (CRBSI)

• Collect paired blood cultures from the catheter and peripheral vein if CRBSI is suspected 1
• Consider empiric antibiotic therapy with vancomycin while awaiting culture results 1
• Remove the PICC if bacteremia with evidence of line-related infection is confirmed 1, 2

Catheter-Related Thrombosis

• Provide therapeutic anticoagulation for at least 3 months for PICC-related DVT 1, 2
• Consider PICC removal only if:
  • No longer clinically necessary
  • Only being used for phlebotomy when peripheral veins are available
  • Symptoms persist despite 72+ hours of therapeutic anticoagulation
  • Line-related infection is confirmed 1, 2

Catheter Occlusion

• Never attempt to force a blocked catheter 1
• For non-functional PICCs, guidewire exchange may be appropriate if no signs of infection are present 1
• Never advance migrated PICCs; guidewire exchange is recommended instead 1

Common Pitfalls to Avoid

• Using multilumen PICCs without clear clinical indication
• Inadequate hand hygiene before catheter manipulation
• Inconsistent dressing change protocols
• Forcing fluid through occluded catheters
• Attempting to reposition migrated catheters
• Removing PICCs with DVT when still clinically necessary
• Using heparin instead of normal saline for routine flushing
• Neglecting daily site assessment

By following these evidence-based guidelines for PICC line care and maintenance, healthcare providers can minimize complications and optimize patient outcomes.