Can a patient with a serious infection and potential underlying conditions, including impaired renal function, run fluids through a single lumen Peripherally Inserted Central Catheter (PICC) line?

Can a Patient Run Fluids Through a Single Lumen PICC Line?

Yes, a patient can safely run fluids through a single-lumen PICC line—in fact, single-lumen PICCs are the preferred default choice and should be used unless there is a documented clinical need for multiple incompatible infusions. 1

Why Single-Lumen PICCs Are Preferred

Default to single-lumen devices whenever possible. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) explicitly rates the default use of single-lumen PICCs as appropriate and identifies this as a potentially important strategy to reduce PICC complications. 1 The guideline specifically rates insertion of multilumen PICCs simply to separate blood sampling from infusions or to ensure a "backup" lumen as inappropriate. 1

Evidence Supporting Single-Lumen Use

• Reduced infection risk: Single-lumen catheters have bloodstream infection rates of 0-5% compared to 10-20% with multilumen devices. 1 A meta-analysis demonstrated that for every 20 single-lumen catheters used instead of multilumen catheters, one bloodstream infection is prevented (NNT = 19). 2

• Lower complication rates overall: Research shows multilumen PICCs are associated with 2-4 fold increased risk of infections, non-infectious complications, and device removal. 3 In orthopedic patients with bone infections, having two or more lumens was an independent risk factor for complications (OR = 2.64). 4

• Cost savings: Moving from 25% to 50% single-lumen PICC utilization saves approximately $119,283 annually per 1,000 PICCs placed, while preventing 2.5 bloodstream infections and 2.5 deep vein thromboses. 3

When Single-Lumen PICCs Are Sufficient

Single-lumen PICCs can accommodate:

• Intravenous fluid administration (crystalloids, maintenance fluids) 1
• Parenteral nutrition (when used exclusively for this purpose) 1
• Long-term antibiotic therapy 5, 4
• Chemotherapy administration 1
• Blood product transfusion 6
• Intermittent medication boluses (when not running continuous incompatible infusions) 1

When Multilumen PICCs Are Justified

Only use multilumen devices when you have a documented rationale for multiple incompatible fluids. 1 Legitimate indications include:

• Simultaneous administration of incompatible medications that cannot be given sequentially (e.g., parenteral nutrition with other medications that cannot be interrupted) 1
• Critically ill patients with poor venous access requiring multiple continuous infusions, though one lumen should still be dedicated to specific therapy 1
• Oncology patients requiring regular blood transfusions or bone marrow transplantation alongside chemotherapy 1

Maintenance and Safety Protocols

Flushing Protocol

• Use normal saline rather than heparin to maintain catheter patency—this is rated as appropriate by MAGIC guidelines. 1
• Flush after each use and at least weekly when not in active use. 7
• Use 10 mL or larger syringes to prevent excessive pressure that can damage the catheter. 7

Infection Prevention

• Dedicate the PICC exclusively to its primary purpose when possible—avoid using it for blood sampling or other purposes. 1
• Use sterile gauze between the PICC entry site and adhesive dressing for the first 1-2 days, then transition to clear transparent dressings. 1
• Change dressings weekly or more frequently if wet, loose, or soiled. 1

Monitoring

• Watch for signs of occlusion, which occurs in approximately 8.9% of PICCs and is more common in patients over 65 years old. 5, 4
• Monitor for infection signs, though PICC-related bloodstream infections are relatively low (1.6% in prospective studies). 5
• Be aware that complication rates are higher during hospitalization (14.38 per 1000 PICC-days) compared to outpatient settings (3.19 per 1000 PICC-days). 5

Critical Pitfalls to Avoid

• Never insert a multilumen PICC "just in case" or to have a backup lumen—this increases infection risk without clinical benefit. 1
• Do not advance a migrated PICC regardless of how far it has dislodged; instead, perform guidewire exchange if there are no signs of infection. 1
• Avoid using the PICC for blood sampling if it's being used for parenteral nutrition or other critical infusions, as this increases manipulation and infection risk. 1
• Do not assume you need multiple lumens for sequential medication administration—proper flushing between medications allows safe use of a single lumen for most patients. 1, 8