I recently had this asked of me and I would like other clinicians thought on this: Is there a certain cut off time for PICC deal time. We have a patient who has had his PICC line in for 2 years for home TPN. It has been functioning great, good patency and assessment of line. He just developed a CR-BSI. The nurse asked me, do you think we should of taken out the PICC line sooner and had it replaced even though it is working well without signs of any complications? I have always believed that if the line is working and no problems leave it in until there is a problem that can't be resolved.
What are your thoughts? Any published studies on appropriate length of deal time?
Thanks ahead of time for your comments.
Carole
There is no maximum length of dwell time recommended for any type of VAD. Removal occurs when there is no longer a need for it or when complications occur. While we know that biofilm grows on the inside lumen, breaks off and produces BSI, there is no way to say that this is more likely to occur at day 5 vs 50 vs 500. So optimum dwell time is unknown and no recommendations to remove and replace at a specific time. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I was taught that one year is a good bet for maximum dwell. We recently had a young man keep his, 15 months, we and wanted to change it. The Dr voted to keep it. He developed a sepsis related to the line soon after that decision.
Were semiquantitative blood cultures obtained? Can this infection be treated via the PICC line to try to save a functional line? Valorie Dunn, BSN, CRNI
Valorie Dunn,BSN, RN, CRNI, PLNC
I had a patient with a PICC line for 2 1/2 years with no complications.
Valorie Dunn,BSN, RN, CRNI, PLNC
We are a small infusion clinic and the pt went to a hosp out of town. I am not able to track down the results myself but the pts Mother asserts that the MD did determine that his sepsis was related to the Picc line. I don't know for sure. They did remove it and replace another one later for him.
There is no recommended optimal dwell time for any type of VAD. There are so many factors involved in the decision about when to remove a VAD. What was the organism causing the infection? If candida, this was probably associated with the PN as this is a common organism with this fluid. If a type of bacteria, this would be related to the care and maintenance of the catheter hub, needleless connetor and IV set. There are no studies on an optimal dwell time probably because this would require such a large study that the cost and time required would be prohibitive. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861