Cheryl Kelley RN BSN, VA-BC
Jeffery Fizer RN, BSN
I think part of the reason we see PICCs increasing has been the fact that there are now power injectible PICCs and the large "Fear Factor" surrounding a subclavian non-tunneled CVC. Interestingly enough, some data is showing that in the hospital ICU setting there is little difference in infection rates between PICCs and non-tunneled CVCs.
Also, non-tunneled CVCs that are impregnated have greatly reduced BSI rates as long as they are properly inserted and maintained.
The key is to be sure you are using the best line for the patient to deliver the therapy and preserve vessel health. Having said that, I feel like the desire to place triple lumen PICC lines "just in case" we need those extra lumens or one clots off has been contributory to some increase in thrombosis.
We tend to forget the standard to use the smallest gauge device that will deliver the therapy.
6 weeks of vancomycin daily or every other day would not require a double or triple lumen but maybe only a 4 french single lumen that would give you a better catheter to vessel ratio.
Also, don't be afraid to use a 3fr. if the patient vasculature demands it.
Having many return customers without changes to the vein (viewed by ultrasound), I don't think that we are damaging their veins. We do have a few exceptions that we have noted changes, but that is the very smallest percentage of patients. Most of our CF patients do not have vessel changes after having many years of PICCs.