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

Guidelines for PICC Line Care

PICC line care should follow standardized protocols to prevent complications such as infection and thrombosis, with right-sided placement preferred over left-sided placement and transparent dressings or sterile gauze used to cover the exit site. 1

Insertion and Placement Considerations

• Right-sided access is preferred over left-sided approach to reduce the risk of thrombosis 1
• The catheter tip should be located at the superior vena cava-right atrium junction to reduce the risk of venous thrombosis 1
• PICCs are appropriate for therapy expected to last less than six months, while tunneled catheters or implantable ports are preferred for longer-term use 1
• For patients requiring parenteral nutrition, a central venous access device is often required to administer high osmolarity mixtures designed to cover nutritional needs fully 1

Dressing and Site Care

• Either sterile gauze or sterile, transparent, semi-permeable dressings can be used to cover the PICC exit site 1
• Transparent dressings permit continuous visual inspection of the catheter site and require less frequent changes 1
• If there is visible pus exuding from the exit site or if the site is bleeding, gauze dressing is recommended until the problem resolves 1
• Regular assessment of the PICC insertion site for signs of complications is essential 2

Maintenance Procedures

• All patients with PICCs should have access to appropriate monitoring and treatment for routine and/or emergency care, with appropriate contact details provided 24 hours per day, seven days per week 1
• An infusion pump should be used for administering solutions through a PICC line for safety and efficacy reasons 1
• Portable pumps can improve patient quality of life compared to stationary pumps 1
• Blood pressure should be measured in the contralateral arm (without the PICC line) to prevent damage to the catheter 2

Complication Prevention and Management

Infection Prevention

• Single lumen catheters are preferred over multiple lumen catheters, as infections occur more frequently with multiple lumen devices 1
• Peripherally inserted central catheters (PICCs) are associated with a lower risk of catheter-related bloodstream infection compared to conventional central venous catheters 1, 3

Thrombosis Prevention

• Monitor for signs of vascular injury or thrombosis (arm pain, swelling, discoloration) 4
• If symptoms of venous occlusion are present, consider ultrasound evaluation 4
• Avoid placement of a new PICC in a vein that had a recent PICC-related thrombosis (within 30 days) 4

Management of Accidental Removal

• If a PICC is self-removed, position the patient flat with the exit site below heart level to reduce risk of air embolism 4
• Apply firm digital pressure at the exit site for at least 5 minutes 4
• Apply an occlusive dressing after bleeding has stopped 4
• Never attempt to reinsert a self-removed PICC 4

Special Considerations

• For patients requiring long-term central venous access (>3 months), tunneled catheters or implanted ports may be more appropriate than PICCs 2
• Patient education about side effects and precautions for use is essential to prevent potential harm, especially for outpatients 5
• The complication rate is typically higher in the hospitalization setting (36.1%; 14.38 per 1000 PICC-days) than in the outpatient setting (19.4%; 3.19 per 1000 PICC-days) 3
• Occlusion and accidental withdrawal are the most common complications, with age >65 and catheter pre-occlusive events associated with increased likelihood of catheter occlusion 3

PICC Removal Criteria

• PICC removal is appropriate when: 1) the PICC has not been used for any clinical purpose for 48 hours or longer; 2) the patient no longer has a clinical indication for a PICC; or 3) the original indication for use has been met 1
• PICC removal without physician notification is inappropriate 1