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Putting a PICC back in the same vein

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 M. Wilson
I do not have evidence (you
I do not have evidence (you mean documentation in the literature) to answer your question. Someone more experienced than I probably does, and I hope you receive it.  Here is how I would think through this situation.
I do not remember reading about or being trained on a rule of 8 weeks. In the INS Core Curriculum book, it talks about site selection.  On your topic, it conveys  the importance of determining vein health, and avoiding injured veins or sclerosed veins.
I think its a pretty individual situation for the most part. I would ask Did the pt. have any trouble with the last picc? This will help you to know about vein integrity. For example, look up the insertion record. Did it go smoothly, or where there multiple attempts and manipulations? These things could impact the health of the vein now. Did the pt. have any trouble, during the course of treatment, with blockage? To your knowledge, do you know if any thrombus formation was  present? What about the pt.....any abnormalities in terms of coagulation disorders? During the pt's previous tx, was there any incident of infilration, or extravasation?
Considering the circumstances of your picc team and the doctor not agreeing (coupled with the pt. needing tx and having no other sites), you could easily do a simple radiological study to determine vein health. Even use your U/S machine for starters.
Go proximal to the last picc insertion site, and of course! use the smallest size picc you can to accomodate the tx.  You have to weigh the risks of putting in the picc near the same spot with the pt. not receiving her tx in this case (you could move on to ports, tunneled, but you would want to make sure you cannot give her a second picc first.....and I don't know the details of her tx and her doctors thoughts on that).
Let us know!


Kathleen Wilson, CRNI

If there were no

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.

Gwen Irwin
Putting a PICC back in the same vein

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


Putting picc back in same vein

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.


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