PICC Line with Suspected Infection: Immediate Discontinuation Required
No, a PICC line with moderate serous drainage and swelling suggesting infection should NOT be used and must be removed immediately. 1
Immediate Actions Required
Discontinue Use and Remove the Line
- Stop all infusions through the PICC line immediately when signs of local infection (drainage, swelling) are present 1
- Remove the PICC line promptly as it is no longer safe for use 1, 2
- The Infectious Diseases Society of America guidelines emphasize that any intravascular catheter that is no longer essential or shows signs of infection should be removed without delay 1
Assess for Infection
- Inspect the exit site for redness, swelling, purulent or serous drainage 3
- Obtain a swab of any exudate for culture and Gram staining before removal 3
- Monitor vital signs including temperature, pulse, blood pressure, and respiratory rate every 4 hours to detect systemic infection 3
- Check for systemic signs of infection including fever, chills, and hypotension 3
- If bacteremia with objective evidence of line-related infection exists, removal is definitively appropriate 1
Why Continued Use is Inappropriate
Infection Risk Outweighs Benefit
- The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) panel rated guidewire exchange or continued use of a PICC as inappropriate when there are signs of local or systemic infection 1
- Even when line-related infection is only suspected but not confirmed, the appropriateness of continued use is neutral at best, meaning the risks are too high 1
- PICC-related infections occur in 1.6-6.3% of cases, with local infections being more common than bloodstream infections 4, 5
Complications of Infected Lines
- Continuing to use an infected PICC can lead to catheter-related bloodstream infection (CR-BSI), which significantly increases morbidity and mortality 1, 6
- The overall complication rate for PICCs is 30.2%, with infection being a major contributor requiring removal 5
After Removal: Determining Need for Replacement
Evaluate Continued Need for Central Access
- Determine if central venous access is still clinically necessary for the patient's care 3, 2
- The American College of Physicians recommends removal when the PICC has not been used for 48 hours or longer, or when no clinical indication remains 2
If Replacement is Needed
- Do not replace the PICC in the same site or vein where infection was present 1, 3
- Wait until the infection has resolved before considering new central access 1
- Consider alternative access sites in the contralateral arm if a new PICC is absolutely necessary 1
- For patients requiring long-term access (>3 months), tunneled catheters or implantable ports may be more appropriate than PICCs 1, 2
Critical Pitfalls to Avoid
- Never attempt to salvage an infected PICC line by treating through it with antibiotics alone—removal is mandatory 1
- Do not delay removal while waiting for culture results if clinical signs of infection are present 1, 3
- Do not perform guidewire exchange of an infected PICC, as this is rated as inappropriate and risks seeding infection along the new catheter tract 1
- Avoid placing a new PICC in a recently infected vein, as this increases risk of recurrent infection 1, 3