What is the proper care of a Peripherally Inserted Central Catheter (PICC) line?

From the Guidelines

Proper care of a PICC line involves keeping the insertion site clean and dry, changing the dressing weekly or when soiled, and flushing the line regularly with saline as prescribed, as recommended by recent guidelines 1.

Key Aspects of PICC Line Care

• Always wash your hands thoroughly before touching the PICC line or dressing.
• Inspect the site daily for signs of infection such as redness, swelling, pain, or discharge.
• Keep the dressing intact and replace it if it becomes wet, loose, or dirty.
• When showering, cover the PICC line with a waterproof covering.
• Flush the line according to your healthcare provider's instructions, typically with 10ml of saline before and after medication administration, or daily if not in use.
• Never use scissors near the line, avoid strenuous activities that could dislodge it, and don't submerge the site in water.
• Contact your healthcare provider immediately if you notice fever, chills, shortness of breath, or issues with the line such as leaking, breakage, or difficulty flushing.

Management of PICC Complications

• In patients with a centrally positioned, otherwise functional PICC that is complicated by image-confirmed PICC-related deep venous thrombosis (DVT), PICC removal is only recommended in specific circumstances, such as when the PICC is clinically no longer necessary or when symptoms of venous occlusion persist despite therapeutic anticoagulation for 72 or more hours 1.
• Guidewire exchange of the PICC is rated as appropriate when changes to existing PICC characteristics are desired or when the PICC is no longer functional, provided that there are no signs of local or systemic infection 1.

Best Practices for PICC Selection and Maintenance

• Default use of single-lumen devices is recommended as an appropriate and potentially important way to reduce PICC complications, unless a documented rationale for a multilumen PICC exists 1.
• Collaboration with pharmacists or vascular access operators before ordering a PICC is recommended to clarify device needs 1.
• Use of normal saline rather than heparin to maintain catheter patency and prevent lumen occlusion is recommended as appropriate, as reflected in recent recommendations 1.

From the Research

Care of PIC Line

• The care of a Peripherally Inserted Central Catheter (PICC) line is crucial to prevent bloodstream infections and clinical sepsis 2.
• A dedicated nursing team can play a significant role in maintaining the PICC line and reducing the incidence of event leading to undesired catheter removal (ELUCR) 3.
• Proper care of catheters can decrease the rate of possible infectious, mechanical, and thrombotic complications compared to traditional central venous catheters 4.
• The use of a vancomycin-heparin lock solution can reduce the incidence of catheter-related bloodstream infection (CRBSI) in high-risk neonates with long-term central catheters 5.
• Midline catheters may be a safe alternative to PICCs for outpatient parenteral antimicrobial therapy (OPAT), particularly for infusions planned for 14 or fewer days 6.

Prevention of Complications

• The use of a vancomycin-heparin lock solution can prevent CRBSI in high-risk neonates with long-term central catheters 5.
• Proper care of catheters can decrease the rate of possible infectious, mechanical, and thrombotic complications 4.
• A dedicated nursing team can reduce the incidence of ELUCR 3.

Types of Catheters

• Midline catheters may be a safe alternative to PICCs for OPAT, particularly for infusions planned for 14 or fewer days 6.
• PICCs can be used for the administration of antimicrobial therapy in the acute care setting 3.
• Traditional central venous catheters can be associated with a higher rate of complications compared to PICCs 4.