PICC Lines and IJ Catheters Should NOT Be Routinely Replaced
In adults, do not replace PICC lines or internal jugular (IJ) central venous catheters routinely to prevent catheter-related infection—these catheters should remain in place as long as they are functioning properly and show no signs of infection or complications. 1
Evidence-Based Replacement Strategy
When to Keep the Catheter In Place
The CDC guidelines explicitly state that central venous catheters (including PICCs and other CVCs like IJ lines) should not be replaced at scheduled intervals for infection prevention in adults 1. This recommendation is based on evidence showing:
- No reduction in catheter-related bloodstream infections (CRBSI) when catheters are routinely changed every 7 days compared to changing only when clinically indicated 1
- Lower infection rates with PICC lines compared to traditional CVCs in long-stay patients (2.2 vs 6.0 infections per 1,000 catheter-days), suggesting these lines can safely remain in place longer 2
- No increased risk from postplacement adjustments of PICCs, which actually showed protective effects against CRBSI 3
When to Remove or Replace the Catheter
Remove or replace PICC lines and IJ catheters only when clinically indicated 1:
- Signs of infection: fever, purulent drainage at insertion site, erythema, warmth, or pain at the vascular site 1
- Catheter malfunction: blockage or inability to flush/draw blood 1
- Suspected CRBSI: positive blood cultures with matching organisms from catheter tip (≥15 colony-forming units) 1
- No longer needed: therapy completed or alternative access established 1
Dressing and Tubing Maintenance (Not Catheter Replacement)
While the catheter itself stays in place indefinitely, associated components require regular changes 1:
Dressing Changes
- Transparent dressings: every 7 days on short-term catheters 1
- Gauze dressings: every 2 days 1
- Earlier replacement if dressing becomes damp, loosened, soiled, or inspection is necessary 1
Administration Set Changes
- Standard IV tubing: no more frequently than every 72 hours 1
- Blood products or lipid emulsions: within 24 hours of initiating infusion 1
Pediatric Considerations
For pediatric patients, no specific recommendation exists regarding routine replacement frequency of central venous catheters including PICCs 1. The same principle of clinically-indicated removal applies, though formal guidelines acknowledge insufficient evidence in this population.
Common Pitfalls to Avoid
Do not confuse peripheral IV catheters with central lines: Peripheral venous catheters should be replaced every 72-96 hours in adults 1, but this does not apply to PICC lines or IJ catheters, which are central venous access devices.
Do not perform routine guidewire exchanges: Meta-analysis of 12 randomized trials showed no reduction in CRBSI rates with routine guidewire exchanges compared to as-needed replacement 1. Guidewire exchange is only appropriate for replacing a malfunctioning catheter or when the insertion site appears uninfected.
Do not remove catheters based on duration alone: One study showed catheters remaining in place up to 28 days without increased day-specific risk for complications 4. Duration of catheterization was the only predictor of infection, but this supports minimizing unnecessary catheter days rather than scheduled replacement 2.
Cost and Patient Comfort Considerations
Avoiding routine replacement provides significant benefits 1:
- Reduces unnecessary procedures that cause patient discomfort and anxiety
- Preserves venous access sites in patients requiring long-term therapy
- Decreases mechanical complications associated with new insertions (pneumothorax, arterial puncture, bleeding)
- Lowers healthcare costs by eliminating unnecessary catheter changes
The evidence consistently supports a "leave it alone if it's working" approach to PICC lines and IJ catheters, with vigilant daily assessment for signs of complications rather than arbitrary replacement schedules.