How often should different types of central venous access devices, such as Peripherally Inserted Central Catheters (PICCs), tunneled central venous catheters, and implantable ports, be changed?

Central Venous Access Device Types and Replacement Intervals

Direct Answer

Central venous access devices should NOT be routinely replaced based on time intervals—they should only be changed when clinically indicated (malfunction, infection, or no longer needed), regardless of device type. 1

Device Types and Expected Duration of Use

Short-Term Devices (1-3 weeks)

• Non-tunneled CVCs: Designed for continuous short-term infusions, drug delivery, hemodialysis, and central venous pressure monitoring 1
• These are 20-30 cm catheters inserted into subclavian, internal jugular, innominate, axillary, or femoral veins 1
• Range from 5F to 14F with single or multiple lumens 1

Intermediate-Term Devices (<3 months)

• PICCs: Non-tunneled catheters inserted through peripheral arm veins (basilica, brachial, or cephalic) extending to the superior vena cava 1
  • Range from 2F to 7F with one to three lumens 1
  • Can be used for up to 3 months in both hospitalized and outpatient settings 1
• Hohn catheters: Non-tunneled, 20-cm silicone catheters inserted centrally 1
  • Available as single lumen (5F) or dual lumen (7F) 1

Long-Term Devices (>3 months)

• Tunneled CVCs: Travel through 8-15 cm subcutaneous tunnel with a cuff that induces fibrosis for fixation and infection prevention 1
  • Sizes range from 3.5F to 21F 1
  • The cuff typically fixes within 3-4 weeks after insertion 1
  • Recommended for patients requiring continuous daily access 1
• Totally implanted ports: Consist of a subcutaneous reservoir connected to a central catheter 1
  • Have the lowest catheter-related bloodstream infection rates compared to tunneled and non-tunneled CVCs 1
  • Reserved for patients requiring long-term intermittent vascular access 1

Critical Recommendation: Do NOT Routinely Replace Catheters

Non-tunneled CVCs should NOT be removed and replaced routinely based on time intervals (Grade A recommendation). 1

Evidence Against Routine Replacement

• Routine removal and replacement without clinical indication does NOT reduce catheter colonization or catheter-related bloodstream infection rates 1
• Routine replacement actually INCREASES the incidence of insertion-related complications 1
• CVCs should be removed ONLY when complications occur or they are no longer necessary 1

When to Change Catheters (Clinical Indications Only)

• Malfunction: Catheter occlusion or inability to infuse/aspirate 1
• Infection: Evidence of exit site infection or proven catheter-related bloodstream infection 1
• No longer needed: Therapy completed or alternative access established 1

Important Caveats About Guidewire Exchange

• Guidewire-assisted catheter exchange has a role ONLY for replacing a malfunctioning catheter 1
• Guidewire exchange is absolutely contraindicated when infection is present at the catheter site or proven CRBSI exists 1
• If catheter-related infection is suspected without exit site evidence, the catheter may be removed and replaced over a guidewire for diagnostic purposes—but if tests confirm infection, the newly inserted catheter must be removed and a new one placed at a different site 1

Device Selection Based on Duration

For Peripherally Compatible Infusates

• ≤5 days: Use peripheral IV catheters or ultrasound-guided peripheral IVs 2
• 6-14 days: Prefer midline catheters over PICCs (lower complication rates) 2
• 15-30 days: PICCs are preferred over midlines (higher midline failure rates beyond 14 days) 2
• ≥31 days: Use tunneled catheters or implanted ports 2

For Vesicants/Irritants (Chemotherapy, Parenteral Nutrition)

• Any duration: PICCs are appropriate because central access is mandatory 2
• 15+ days: Non-tunneled CVCs are appropriate if skilled operators available 1
• 31+ days: Tunneled catheters or implanted ports are appropriate 1

Common Pitfalls to Avoid

• Do NOT place PICCs for <6 days with peripherally compatible infusates—this is inappropriate and increases unnecessary complications 2
• Do NOT routinely replace catheters at scheduled intervals (e.g., every 72-96 hours)—this increases complications without reducing infection 1
• Do NOT use midline catheters for vesicants/irritants—they lack central access and risk extravasation 2
• Do NOT place PICCs in chronic kidney disease patients (stage 3-5) at risk for dialysis—this compromises future dialysis access 2

Accessory Component Replacement

While the catheter itself should not be routinely replaced, certain components require scheduled changes:

• Administration sets: Change every 24 hours when using lipid-containing parenteral nutrition, or every 72 hours if lipids are not infused 1
• All fluid administration tubing and connectors must be replaced when the central venous access device is replaced 1
• Needle-free connectors: Follow manufacturer's recommendations for changing these components 1