What is the maximum duration a Peripherally Inserted Central Catheter (PICC) can stay in?

From the Guidelines

A PICC line can remain in place for up to 12 months if properly maintained, but the decision to remove it should be based on the individual patient's condition and the development of any complications, with a general guideline of removal after 15 days or longer for critically ill patients and those with cancer, as suggested by the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) 1.

Key Considerations

• The duration of PICC placement depends on the reason for placement, patient condition, and development of complications.
• Regular maintenance, including weekly dressing changes and flushing with saline or heparin, is necessary to prevent complications.
• The site should be monitored for signs of infection, and the PICC may need to be removed earlier than planned if complications occur.
• The decision to remove a PICC is typically made by the healthcare provider based on whether the treatment requiring central venous access is complete and whether the line remains necessary for the patient's care.

Guidelines for PICC Placement and Removal

• For hospitalized medical patients, PICC insertion is rated as inappropriate if the expected duration of use is 5 or fewer days, and peripheral intravenous catheters or ultrasonography-guided peripheral intravenous catheters are preferred 1.
• For durations of 6 to 14 days, PICC use is rated as appropriate, but midline catheters and ultrasonography-guided peripheral intravenous catheters are preferred over PICCs for this period.
• For durations of 15 or more days, PICCs are preferred to midline catheters, given the possibility of failure of the latter beyond this period.

Patient-Specific Considerations

• Critically ill patients and those with cancer may require PICC placement for longer durations, with a general guideline of 15 days or longer 1.
• The risk of complications, such as infection and thrombosis, should be carefully considered when deciding on the duration of PICC placement.
• Patient-specific factors, such as the presence of suitable veins and the feasibility of PICC placement, should also be taken into account when making decisions about PICC placement and removal.

From the Research

Duration of PICC Stay

• The duration of a PICC stay can vary depending on the patient's condition and the purpose of the catheter 2.
• The median duration of in situ PICC placement was 101 days (interquartile range, 48-184 days) in a study of patients with hematologic malignancies 2.
• Another study found that the median time of PICC-related bloodstream infection onset was 42 days 3.

Complications and Risks

• PICC use is related to some complications, including bloodstream infections and venous thrombosis 4, 5, 6.
• The risk of PICC-related complications can be guided by a conceptual model that outlines recommendations for clinicians to prevent adverse events 4.
• Factors such as younger age, history of venous thrombosis, and therapy with certain medications can increase the risk of PICC-related complications 6.

Safety and Efficacy

• PICCs can be a safe and effective alternative to conventional central venous access devices for patients with hematologic malignancies 2.
• Antibiotic lock therapy can be a safe and effective approach for managing PICC-related bloodstream infections in patients with hematological malignancies 3.