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

Duration of PICC Line Use

PICC lines should be used for 15-30 days for peripherally compatible infusions, with no routine replacement needed as long as the device is functioning properly and no complications are present. 1, 2

Appropriate Duration Based on Infusion Type

For Peripherally Compatible Infusions:

• ≤5 days: PICC use is inappropriate; use peripheral IV or ultrasound-guided peripheral IV instead 1
• 6-14 days: Midline catheters preferred over PICCs 1, 2
• 15-30 days: PICCs are appropriate and preferred over midline catheters 1, 2
• ≥31 days: Consider tunneled catheters or implanted ports 1, 2

For Non-Peripherally Compatible Infusions (irritants/vesicants):

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

Clinical Considerations

Specific Clinical Scenarios:

• Parenteral Nutrition:

  • Short-term inpatient PN: Both non-tunneled CVCs and PICCs are suitable 1
  • Medium-term or home PN: PICCs, Hohn catheters, tunneled catheters, or ports are appropriate 1
  • Prolonged use (>3 months): Tunneled catheter or port is advised 1

• Hemodialysis:

  • PICCs should generally be avoided in patients with chronic kidney disease stage 3 or worse to preserve veins for future dialysis access 1

Complications and Monitoring:

• The risk of complications increases with duration of use:

  • Catheter-related bloodstream infections: 0.56-1.63 per 1000 catheter days 3
  • Mechanical complications (occlusion, accidental removal): 13.5% and 9.6% respectively 4
  • Most complications occur during the first week after insertion 5

• Regular monitoring is essential:

  • Evaluate the catheter insertion site daily by palpation through the dressing 2
  • Visually inspect the site if a transparent dressing is used 2
  • Remove PICC if signs of phlebitis develop (warmth, tenderness, erythema, palpable venous cord) 2

Important Considerations for PICC Selection

• Catheter size matters: Smaller gauge catheters (3F) have fewer complications than larger ones (4F) 5
• Insertion technique: PICCs requiring multiple insertion attempts have higher complication rates 5
• Patient factors: Consider difficult venous access and teaching hospital settings, which are associated with short-term PICC use 6
• Avoid short-term use: PICCs used for ≤5 days still have a 9.6% complication rate, including 2.5% venous thromboembolism 6

Conclusion

While PICCs can remain in place for extended periods without routine replacement, their use should be carefully matched to the expected duration of therapy. For short-term therapy (≤5 days), peripheral IVs are preferred; for medium-term therapy (6-14 days), midline catheters are preferred; and for longer-term therapy (≥15 days), PICCs become appropriate. For very long-term therapy (≥31 days), tunneled catheters or implanted ports should be considered.