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In dwell time for groshong single lumen picc

I would just like your opinion or some direction toward any evidence, which would collate with this pt's situation.

Pt has had a single lumen, 4fr groshong picc insitu for 12months 3 days.  Not once has this pt had any adverse experience from the line.  he occasionally gets some skin irritation from the transparent dx.  The treating team is wondering should they remove the line as it has now exceeded the indwell time that is indicated for that product.  The catheter and pt are coexisiting perfectly.  I suggested that the pt have a venogram done so the central venous flow could be assesed and to see if any colatteral systems had been developed or if there was any evidence of thrombus.  The venogram results were encouraging, with no evidence of thrombus and only some small areas or colateral vessels in the mid upper arm, which may have already been there as the pt has had previous Picc insertions.

The pt has had a history of difficult access in the past, so to get this line to stay functional as long as it has is remarkable.

 QUESTION: Should we leave it or lose it?

Hello from Down under ( Brisbane, Australia)

Rachel Muller, Clinical Nurse Consultant, Bard Access Systems

Halle Utter
You don't mention what the

You don't mention what the line is being used for.  Is it a continuous or intermittent use? 

I had a patient in the past that had a PICC line for well over 2 years without problems. He was on TPN and continuous Morphine.  He also had extremely difficult access issues.  While it is unusual to have a PICC line in for such an extended dwell time, there are always exceptions.  As long as there are no signs of line infection, site or systemic, I would leave the line in and just monitor for any signs of infection.  I always teach my patients to watch for early signs of intraluminal infection.  If the line is used intermittently, I tell them to pay special attention when they first flush the line after it has been "sitting" with nothing going through it.  If they experience a brief period of malaise, low grade fever, flu-like feelings right after flushing, it usually indicates that the line is growing bacteria that are multiplying inside the lumen.  When they flush, they are spraying the bacteria into their bloodstream, and experience brief bacteremic symptoms that then abate.  This is an early sign of infection that can be identified and the line can be removed before the patient develops full blown sepsis.  I realize that's more information than you asked for, but if the line is working, shows no signs of complication, and replacing with a more permanent line is not an option or pt doesn't wish to, I see no reason no to leave it and continue your close monitoring.  

Hallene E Utter, RN, BSN Intravenous Care, INC

I am not sure what you are

I am not sure what you are referencing for the maximum indwelling time for a catheter, but there is no such time limits to my knowledge. CDC guidelines state that the maximum dwell time for any PICC or any other CVC is unknown. So if there are no complications, problems, etc. I would leave it alone and not remove it. Lynn


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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