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PICC exchange

I don't remember the discussion about this, but I did promise to post this study. It is the only data I have seen on the risk associated with CVAD exchange 


Exchange of peripherally inserted central cat... [Am J Perinatol. 2011] - PubMed - NCBI

. Am J Perinatol. 2011 Jun;28(6):419-24. doi: 10.1055/s-0030-1268709. Epub 2010 Nov



Exchange of peripherally inserted central catheters is associated with an

increased risk for bloodstream infection.

McCoy M, Bedwell S, Noori S.


Section on Neonatal-Perinatal Medicine, Department of Pediatrics, University of

Oklahoma Health Sciences Center, USA.


It is not uncommon that the peripherally inserted central catheter (PICC) needs

to be replaced either due to blockage or migration to a peripheral position. In

such circumstances, there are two methods of PICC placement: new-site insertion

and exchange by using the old PICC as a guide wire. Our objective was to

investigate risk of infection associated with the exchange method. In this

retrospective study, data on all PICC insertions in the neonatal intensive care

unit in 2004 to 2008 were obtained. In the population who needed removal of

existing PICC and insertion of a new one, we compared central line-associated

bloodstream infection (CLABSI) within 1 week of insertion between the two

insertion methods. Of 1148 PICC insertions reviewed, 164 (103 new-site and 61

exchange insertions) were performed after removal of a blocked/malpositioned PICC

and therefore comprised the study population. The rate of CLABSI was higher in

the exchange method (9.8% versus 1%, P < 0.007). After adjusting for the

confounders, the odds for CLABSI within 7 days of PICC insertion was higher with 

the exchange method (odds ratio 25.2, 95% confidence interval: 2.17 to 292.98; P 

= 0.01). In infants, insertion of PICCs using the exchange method carries an

increased risk of bloodstream infection.


© Thieme Medical Publishers.


PMID: 21082537  [PubMed - indexed for MEDLINE]