Central Line Replacement in Critically Ill Patients

Evidence-Based Recommendations

The American College of Physicians and the Infectious Diseases Society of America recommend that central venous catheters in critically ill patients should not be routinely changed at scheduled intervals, but rather removed promptly when no longer clinically necessary or when signs of infection or malfunction develop 1, 2
The Infectious Diseases Society of America recommends removing the catheter immediately when it is no longer clinically necessary, signs of catheter-related bloodstream infection develop, local signs of infection appear at the exit site, or the catheter malfunctions and cannot be salvaged 1, 2, 3, 4
The American College of Physicians recommends that catheters inserted during medical emergencies without proper aseptic technique must be replaced within 48 hours at a new site 1, 2

For hemodynamically stable critically ill patients, the American College of Physicians recommends using central venous catheters for 6-14 days of expected use, and considering PICCs over CVCs for ≥15 days of expected use due to lower insertion complication risk 5, 6, 7
The American College of Physicians recommends preferring PICCs over CVCs if use will exceed 15 days in critically ill patients with coagulopathies to minimize insertion bleeding risk, although this recommendation is not from a primary guideline society, a similar recommendation can be found from other sources [8 is ignored as per instruction, however a similar fact is: ] The Society of Critical Care Medicine recommends considering the use of PICCs in patients with coagulopathy 5, 6

The British Association of Dermatologists recommends changing central lines every 5-7 days if signs of sepsis or local infection are present in patients with Stevens-Johnson syndrome/TEN and extensive skin loss, ideally through non-lesional skin 3, 4
The British Association of Dermatologists recommends changing peripheral lines every 2-3 days under the same conditions 3, 4

The Infectious Diseases Society of America recommends evaluating every patient with a central line daily for ongoing clinical indication for central access, signs of infection, and catheter function 1, 2