When to replace Peripherally Inserted Central Catheters (PICC) lines or Internal Jugular (IJ) catheters in patients?

When to Replace PICC Lines and Internal Jugular Catheters

Do not routinely replace PICC lines or internal jugular catheters at scheduled intervals—replace them only when clinically indicated, such as signs of infection, catheter malfunction, or when no longer needed. 1, 2

Evidence-Based Replacement Strategy

The CDC guidelines provide Category IB evidence (strong recommendation) that central venous catheters, including PICCs and IJ catheters, should remain in place as long as they function properly without signs of complications. 1, 2 Routine replacement at fixed intervals (e.g., every 7 days) does not reduce catheter-related bloodstream infections compared to clinically-indicated replacement. 2

Specific Clinical Indications for Replacement

Replace PICC lines or IJ catheters when any of the following occur:

Infectious Complications

• Signs of local infection: purulent drainage, erythema, warmth, or pain at the insertion site 2
• Suspected catheter-related bloodstream infection (CRBSI): positive blood cultures with matching organisms from catheter tip 2
• Fever alone is NOT an indication for removal—use clinical judgment to assess whether infection is present elsewhere or if a non-infectious cause exists 1

Mechanical Complications

• Catheter malfunction: blockage, inability to flush or draw blood 2
• Catheter migration to a peripheral position 3
• Accidental withdrawal (occurs in approximately 8.9% of cases) 4
• Occlusion (occurs in approximately 8.9% of cases, more common in patients >65 years) 4

When No Longer Needed

• Remove the catheter as soon as therapy is complete to minimize infection risk and preserve venous access sites 2

Critical Pitfalls to Avoid

Do not use guidewire exchanges routinely for infection prevention. 1 This approach:

• Does not reduce CRBSI rates 1, 2
• Should only be performed when replacing a malfunctioning catheter with no evidence of infection present 1
• Never use guidewire exchange for suspected infected catheters 1
• In neonates, the exchange method carries a 25-fold increased risk of bloodstream infection within 7 days (OR 25.2,95% CI: 2.17-292.98) 3

Expected Complication Rates

Understanding baseline complication rates helps inform clinical decision-making:

• Overall complication rate: 30.2% (11.1 per 1000 PICC-days) 4
• Bloodstream infections: 1.6% 4
• Local infections: 4.7% 4
• Venous thrombosis: 1.6-4.82% 4, 5
• Mean time to complication onset: 16.1 days 4

Cost and Patient Benefits

Avoiding routine replacement provides substantial advantages:

• Reduces device-related costs by approximately AUD $7.00 per catheter 6
• Decreases unnecessary painful procedures for patients 2, 6
• Preserves limited venous access sites 2
• Reduces mechanical complications from repeated insertions 2

Maintenance Requirements (Not Replacement)

While catheters should not be routinely replaced, proper maintenance is essential:

• Transparent dressings: change every 7 days 2
• Gauze dressings: change every 2 days 2
• Standard IV tubing: change no more frequently than every 72 hours 2
• Inspect insertion site at each shift change for signs of complications 6