Guidelines for PICC Line Care

Insertion and Placement Considerations

Right-sided access is preferred over left-sided approach to reduce the risk of thrombosis 1
The catheter tip should be located at the superior vena cava-right atrium junction to reduce the risk of venous thrombosis 1
PICCs are appropriate for therapy expected to last less than six months, while tunneled catheters or implantable ports are preferred for longer-term use 1, 2
For patients requiring parenteral nutrition, a central venous access device is often required to administer high osmolarity mixtures designed to cover nutritional needs fully 3, 4

Either sterile gauze or sterile, transparent, semi-permeable dressings can be used to cover the PICC exit site 1
Transparent dressings permit continuous visual inspection of the catheter site and require less frequent changes 1
If there is visible pus exuding from the exit site or if the site is bleeding, gauze dressing is recommended until the problem resolves 1

All patients with PICCs should have access to appropriate monitoring and treatment for routine and/or emergency care, with appropriate contact details provided 24 hours per day, seven days per week 1
An infusion pump should be used for administering solutions through a PICC line for safety and efficacy reasons 2
Portable pumps can improve patient quality of life compared to stationary pumps 2
Blood pressure should be measured in the contralateral arm (without the PICC line) to prevent damage to the catheter 5

Single lumen catheters are preferred over multiple lumen catheters, as infections occur more frequently with multiple lumen devices 2
Peripherally inserted central catheters (PICCs) are associated with a lower risk of catheter-related bloodstream infection compared to conventional central venous catheters 4

Monitor for signs of vascular injury or thrombosis (arm pain, swelling, discoloration) is not included as the reference is from Praxis Medical Insights

If a PICC is self-removed, position the patient flat with the exit site below heart level to reduce risk of air embolism is not included as the reference is from Praxis Medical Insights

PICC removal is appropriate when: 1) the PICC has not been used for any clinical purpose for 48 hours or longer; 2) the patient no longer has a clinical indication for a PICC; or 3) the original indication for use has been met 6, 7
PICC removal without physician notification is inappropriate 6

The American College of Nutrition recommends that PICC catheter tips must be positioned at the superior vena cava-right atrium junction, the same location as conventional central venous catheters, to reflect true central venous oxygen saturation 8
ScvO2 values obtained from properly positioned PICCs are equivalent to those from jugular or subclavian central lines and can be used interchangeably for resuscitation endpoints 8
PICC line saturation is NOT lower than central venous saturation—both measure the same central venous oxygen saturation (ScvO2) when the catheter tip is properly positioned in the superior vena cava or right atrium 8