I have been looking for evidence that shows how soon you can put a PICC line back into the same vein. For example, had a patient with a PICC for several months, PICC was pulled, patient was re-admitted within 30 days and we were asked to put a PICC back in. We assessed for another vein, but the patient didn't have one. When we explained to the physician that we couldn't back into the same vein, he became very upset and said that was unheard of and he wanted the evidence to back it up. He said they put central lines back in the same veins all the time and ports dwell for years. Tried to explain that we were giving the basilic/cephalics veins time to heal and that it wasn't an issue of the terminal end in the central catheter. We typically allow for a minimum of 8 weeks for healing. Can anyone give me some direction. I hope this wait time wasn't just pulled out of the air, but I can't find anything to back it up. I would like to provide him with literature....Thanks
Kathleen
Kathleen Wilson, CRNI
If there were no complications with the line/vein/inserion site at the time of removal, then reinsertion shouldn't be a problem. The initial needle stick is no more traumatic then a blood draw. The introducer insertion over a wire really just streaches the needle hole. When the introducer/PICC is removed the musculature of the vein normally constricts back to its usual shape. This is why most PICC sites o not bleed upon removal. There will be some clot formation as the body seals the small hole and the vein layers heal, but this happens in a matter of hours or days rather than weeks. The pre-procedure assessment of the vessel is really the most important issue. When assessing the veins for a new PICC, if the insertion site is compressable with no appearence of clot formation, and the path seems clear up to the axillae, than reinsertion shouldn't be a problem.
We do not require a specific time to elapse before reinserting.
I agree that the pre-procedure assessment is vital. Is the vein size consistent or enlarging as you assess its path up the arm with ultrasound? Is it easily compressible? Is the skin integrity from the previous site an issue? If all is well, we would insert.
I don't recall seeing any published data that would indicate avoiding the use of the same vein. If anyone has, please share.
Gwen Irwin
Austin, Texas
Been re-inserting piccs back in same vein for years and have great success. Dwell time of initial picc varied from hours to days/weeks. Time to reinsertion into same vein varied from hours to days. That's providing no other exclusions are present on the re-assessment. I also was unable to locate any studies etc. that state using the same vein for reinsertion is an exclusion, nor was I able to find anything relating to "time" being a limitating factor for reinsertion. Though "un-scientific", one of the issues I HAVE experienced preventing successful reinsertion in the same vein is the apparent build up of fibrin in the vein itself. Length of time original picc was in place prior to removal (regardless of "how soon" picc reinserted) tends to correlate with this phenenom. However, all patients seem to differ in how their venous anatomy reacts to an indwelling picc (or midline) so a successful reinsertion into the same vein (again, providing no other exclusions present) does not appear to be time related. An interesting study would be if patients present with a higher risk of developing a DVT/phlebitis when a picc is reinserted into the same vein it was removed from and if time is related to that.
IV GUY