{"id":53828,"date":"2026-10-12T08:01:00","date_gmt":"2026-10-12T07:01:00","guid":{"rendered":"https:\/\/campusvygon.com\/uk\/?p=53828"},"modified":"2026-09-18T14:17:19","modified_gmt":"2026-09-18T13:17:19","slug":"neonatal-picc-and-midline-removal-when-is-the-right-time","status":"publish","type":"post","link":"https:\/\/campusvygon.com\/uk\/neonatology\/neonatal-vascular-access-a-practical-guide-to-piccs-and-midlines\/neonatal-picc-and-midline-removal-when-is-the-right-time\/","title":{"rendered":"Neonatal PICC and Midline Removal: When Is the Right Time?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><em>Part 6 of the series: Neonatal Vascular Access: A Practical Guide to PICCs and Midlines<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Introduction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Considerable attention is rightly given to device selection, insertion and maintenance, yet timely catheter removal is equally important. A vascular access device that is no longer clinically required should not simply remain in situ because it is functioning well. Every additional day exposes the infant to potential risks, including infection, thrombosis, migration and accidental dislodgement.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The challenge for clinicians is balancing the risks of keeping a device against the possibility that vascular access may soon be required again. Effective decision-making relies on daily assessment, multidisciplinary communication and a clear understanding of the infant&#8217;s treatment plan.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<h2 class=\"wp-block-heading\">Why Removal Decisions Matter<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Removing a PICC or Midline too early may lead to additional cannulation procedures if intravenous therapy is restarted. Conversely, leaving a device in place without a clear indication may expose the infant to avoidable complications.<sup>1,3<\/sup><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The objective should be simple:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Maintain vascular access only for as long as the benefits outweigh the risks.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This principle supports both patient safety and vessel preservation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Daily Necessity Assessment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every PICC and Midline should undergo a daily review to determine whether it remains clinically indicated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Daily Line Necessity Checklist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ask:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Is intravenous therapy still required?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Is parenteral nutrition still being administered?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Can medications be transitioned to an enteral route?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Is future IV therapy genuinely anticipated?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Does the benefit of the device still outweigh the associated risks?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 If this device were not present today, would we insert it?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The final question is often the most revealing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If the answer is <strong>no<\/strong>, removal should be considered.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Common Indications for Planned Removal<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Therapy Completion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most common reason for elective removal is completion of therapy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Examples include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Completion of intravenous antibiotics<\/li>\n\n\n\n<li>Discontinuation of parenteral nutrition<\/li>\n\n\n\n<li>Resolution of hydration requirements<\/li>\n\n\n\n<li>Transition to enteral feeding and medication administration<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Change in Clinical Condition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Improvements in clinical status may remove the need for ongoing vascular access.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Examples include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Feeding tolerance established<\/li>\n\n\n\n<li>Respiratory stability achieved<\/li>\n\n\n\n<li>Reduced monitoring requirements<\/li>\n\n\n\n<li>Preparation for discharge<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Transition to Alternative Access<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Occasionally, removal is appropriate because an alternative device better suits the patient&#8217;s needs.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">When Removal Should Be Delayed<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Although unnecessary devices should not remain in situ, premature removal is also problematic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinicians should consider:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Is additional therapy likely?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For example:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Blood cultures pending<\/li>\n\n\n\n<li>Further antibiotic decisions expected<\/li>\n\n\n\n<li>Potential feeding intolerance<\/li>\n\n\n\n<li>Anticipated clinical deterioration<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>How difficult would replacement be?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In some extremely preterm infants with limited vascular access, re-establishing access may be particularly challenging.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The decision should therefore consider both current and predicted treatment needs.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Planned vs Unplanned Removals<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Monitoring removal patterns can provide valuable insight into vascular access quality.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Planned Removals<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Examples include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Therapy completed<\/li>\n\n\n\n<li>Clinical goals achieved<\/li>\n\n\n\n<li>Device no longer necessary<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Planned removals generally indicate successful vascular access management.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Unplanned Removals<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Examples include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Occlusion<\/li>\n\n\n\n<li>Dislodgement<\/li>\n\n\n\n<li>Migration<\/li>\n\n\n\n<li>Suspected infection<\/li>\n\n\n\n<li>Catheter damage<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">High rates of unplanned removals may highlight opportunities for improvement in insertion, maintenance or securement practices.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Removal Data Can Teach Us<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every catheter removal provides an opportunity to learn.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>High Occlusion-Related Removal Rates May Indicate:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Inconsistent flushing practices<\/li>\n\n\n\n<li>Delayed recognition of dysfunction<\/li>\n\n\n\n<li>Patency management challenges<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>High Dislodgement Rates May Indicate:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Securement issues<\/li>\n\n\n\n<li>Dressing failures<\/li>\n\n\n\n<li>Inadequate handling procedures<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>High Infection-Related Removals May Indicate:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bundle compliance concerns<\/li>\n\n\n\n<li>Increased catheter manipulation<\/li>\n\n\n\n<li>Maintenance practice variation<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>High Migration Rates May Indicate:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Inadequate monitoring<\/li>\n\n\n\n<li>Securement challenges<\/li>\n\n\n\n<li>Documentation inconsistencies<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Reviewing these trends can support quality improvement initiatives across the NICU.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Clinical Scenario<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Should This PICC Be Removed?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 32-week infant has completed a 10-day antibiotic course.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Current status:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Respiratory support discontinued<\/li>\n\n\n\n<li>Full enteral feeds established<\/li>\n\n\n\n<li>No intravenous medications prescribed<\/li>\n\n\n\n<li>PICC remains functional<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The clinical team discusses whether the PICC should remain &#8220;just in case&#8221; further access becomes necessary.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Key Considerations<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Is there a current indication for IV access?<\/li>\n\n\n\n<li>Is further treatment anticipated?<\/li>\n\n\n\n<li>Does keeping the device reduce or increase risk?<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In this scenario, if no further intravenous therapy is planned, removal would typically be appropriate because the risks of maintaining access may outweigh any potential benefit.<\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Safe Removal Principles<\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Prior to removal, clinicians should:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Confirm the indication for removal<\/li>\n\n\n\n<li>Review local protocols<\/li>\n\n\n\n<li>Prepare all required equipment<\/li>\n\n\n\n<li>Communicate with the multidisciplinary team<\/li>\n\n\n\n<li>Inform and support parents or caregivers<sup>1<\/sup><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Following removal:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Inspect the catheter to confirm it is intact<\/li>\n\n\n\n<li>Assess the insertion site<\/li>\n\n\n\n<li>Document findings<\/li>\n\n\n\n<li>Monitor the site according to local policy<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Talking to Parents About Removal<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Parents often view PICCs and Midlines as symbols of their baby&#8217;s illness.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Removal may therefore prompt a mixture of reassurance and anxiety.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Helpful discussions might include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Why the line is no longer required<\/li>\n\n\n\n<li>How treatment goals have changed<\/li>\n\n\n\n<li>What happens if access is needed again<\/li>\n\n\n\n<li>Signs clinicians will continue to monitor<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">These conversations help support family-centred care and reinforce clinical progress.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Key Practice Points<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Review catheter necessity every day.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Remove devices as soon as they are no longer clinically indicated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Avoid &#8220;just in case&#8221; decision-making.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Monitor planned versus unplanned removal rates.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Use removal data to drive quality improvement.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u2705 Remember that vessel preservation includes timely catheter removal.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Removal is not the end of the vascular access journey. It is an important clinical decision that should reflect the infant&#8217;s current and anticipated needs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">By incorporating daily necessity reviews, monitoring removal trends and using data to inform practice, neonatal teams can reduce unnecessary catheter exposure while preserving future vascular access options. Successful vascular access management depends not only on placing the right device, but also on recognising when it is no longer needed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Next Article:<\/p>\n\n\n\n<div class=\"wp-block-media-text alignwide is-stacked-on-mobile is-vertically-aligned-center is-image-fill-element has-white-color has-text-color has-background has-link-color wp-elements-1\" style=\"background-color:#004431;grid-template-columns:20% auto\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"http:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2026\/04\/shutterstock_Neonate-VA-1024x683.jpg\" alt=\"\" class=\"wp-image-53817 size-full\" style=\"object-position:50% 50%\" srcset=\"http:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2026\/04\/shutterstock_Neonate-VA-980x653.jpg 980w, http:\/\/campusvygon.com\/uk\/wp-content\/uploads\/sites\/9\/2026\/04\/shutterstock_Neonate-VA-480x320.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) 1024px, 100vw\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading has-white-color has-text-color has-background\" style=\"background-color:#004431;font-size:22px\"><strong>Building a Neonatal Vascular Access Pathway in the NICU<\/strong><\/h2>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-fill\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/campusvygon.com\/uk\/neonatology\/neonatal-vascular-access-a-practical-guide-to-piccs-and-midlines\/building-a-neonatal-vascular-access-pathway-in-the-nicu\/\">Learn more<\/a><\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Supporting Materials<\/strong><\/p>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Sharpe EL, Wyckoff MM, Pettit J, et al. <em>Peripherally Inserted Central Catheters: Guideline for Practice<\/em>. 4th ed. Chicago (IL): National Association of Neonatal Nurses; 2024.<\/li>\n\n\n\n<li>Sharpe EL, Pettit J. NANN neonatal peripherally inserted central catheters: clinical practice update. <em>Adv Neonatal Care<\/em>. 2024;24(4):e95-e107.<\/li>\n\n\n\n<li>Infusion Nurses Society. <em>Infusion Therapy Standards of Practice<\/em>. 9th ed. Norwood (MA): Infusion Nurses Society; 2024.<\/li>\n\n\n\n<li>Chen JW. <em>Neonatal Vascular Access: Pearls, Proficiency and Innovation in Practice<\/em>. Academy of Neonatal Nursing Annual Conference; 2018.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Part 6 of the series: Neonatal Vascular Access: A Practical Guide to PICCs and Midlines Introduction Considerable attention is rightly given to device selection, insertion and maintenance, yet timely catheter removal is equally important. A vascular access device that is no longer clinically required should not simply remain in situ because it is functioning well. [&hellip;]<\/p>\n","protected":false},"author":141,"featured_media":53817,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[119],"tags":[67,30,121],"class_list":["post-53828","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neonatal-vascular-access-a-practical-guide-to-piccs-and-midlines","tag-neonatal-vascular-access","tag-neonatalogy","tag-npiccs"],"acf":[],"_links":{"self":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/53828","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/users\/141"}],"replies":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/comments?post=53828"}],"version-history":[{"count":5,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/53828\/revisions"}],"predecessor-version":[{"id":53861,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/53828\/revisions\/53861"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media\/53817"}],"wp:attachment":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media?parent=53828"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/categories?post=53828"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/tags?post=53828"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}