Is there a recommended dwell time for PICCs? I know the current INS Standards state the dwell time for PICCs is unknown. Is there anything else on that subject? My workplace is considering mandating changing a PICC when it has been indwelling for 1 year, but I've never heard or read of such an arbitrary practice for any central line. This would apply to PICCs that are functioning well without any clinical issues.
No, there are no studies that have established the optimum time for removal of a PICC that is functioning without any problems. Actually we only have this information for short peripheral catheters, but not for any other type of catheter including PICCs.
To establish this recommended length of dwell, we would need studies that have examined the length of dwell time in a large number of patients compared to when and why those catheters were removed. The common analytical method for this calculation is known as the Kaplan-Meier Product Limit Estimator.
Studies on short peripheral catheters have used this method, however I am not aware of any studies on PICCs or CVCs that have made any attempt to calculate this point in time. This method specifically looks at the failure rates such as the point in time when 50% of catheters have failed from a catheter-related reason such as a complication.
You mentioned the INS standards of practice as the source for this. Actually the first source was and still is the CDC guidelines. Both documents are in the revision process now. I am not sure what the final content will include, however I do not think that any specific time period can be established because we simply do not have the data.
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The Society of Interventional Radiology have made some suggestions in a 2010 article. Reference: Chrisman, H. B., Vesely, T. M., & Denny, D. F. (Eds.). (2010). Venous Access. Society of Interventional Radilogy. They suggest 6 weeks to 3 months as a recommendation because a PICC is a non-tunneled catheter.
Thanks for the reference but I can not locate it through PubMed or Google Scholar. Is this a book or journal article?
I will need to see their exact wording. I suspect what they are saying is that a PICC is suggested for therapies ranging from 6 weeks to 3 months. This is definitely not the same thing as optimum dwell time. Optimum dwell time is the maximum time that a catheter should dwell. This is established by conducting research and calculating the Kaplan Meier Product Limit Estimator. A shortcut to understanding this statistical method is to think of it as the point in time when 50% of the study catheters have failed from a catheter-related reason. These reasons are identified in the study planning phase. To my knowledge this type of statistical analysis has not been done for any catheter other than short peripheral catheters. This data result is then used to establish the standard for the optimum or maximum dwell time. While these are recommendations for the length of therapy suited for a PICC, I would not regard this as a national standard for optimum or maximum dwell time. In other words, this does not mean that all PICC should be removed at 3 months dwell time.
I would like to read this study so if you can provide more information about how I can locate it, I would appreciate it. Thanks for sharing.
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