Personally, I think a catheter exchange is a last effort. I do them as infrequently as possible.
As soon as the PICC is placed, fibrin has started to adhere to the line. No one knows show much, some patients have more than others. If a line is in place for say a week, then it is exchanged, the fibrin doesn't usually come out of the vein, it stays and then is eventually dissolved. How long does this process take-to dissolve away? I have a ultrasound picture of fibrin left inside a vessel after the line was removed. Now think about doing a re-thread into that same vessel. It can enter the same fibrin that was on your previous PICC. I pereonally try to do a new stick, in the oppisite extremity. If I can't, mastectomy etc., then I will do an exhange, but I am very leary of this. We so about 150 PICC's month and only 2 or so exhanges. These are usually for lines that are being down sized or a patient who has started TPN and needs a dual. It also is early in the existence of the line. We would never do an exhange for a line that is not functioning 100%, for example, it has withdrawal occlusion. There is a risk of infection and thrombus formation with exhanges. Lastly, we never do an exhange for suspected infection, we go in the opposite arm. Hope this helps, Cheryl, aka fruit loop West Virginia University Hospitals
