[Case report on deviant care measures of a PICC line on a palliative patient]

A PICC line is a peripheral, through a vein inserted, central venous catheter. There are different engineered stabilisation devices - some are with and some without a sutural. This is an individual case-report which only looks at one concrete fixing system with an adhesive plate (StatLock®).In an internet search on 12/2017 the usual care-recommendation refers mainly to a document of Charité - Universitätsmedizin Berlin (04/2014). It is recommended to change the adhesive plate and the plaster every seven days. Also irrigations during the change of the adhesive plate and after each use of the PICC line are recommended. This procedure also includes the take off and new fixation of the adhesive plate as well as the disinfection and cleaning of the skin and the fixation of the plaster.This case report looked at a 65 years old masculine, cachectic, palliative patient with a metastasizing prostate cancer in a weak condition. He was able to move within his residential area. He had no cognitive or psychological impairment.The installation of the PICC line on the left upper arm was done in 04/2017. When the patient came to our mobile palliative team one of the lines was used for pain therapy with a PCA-pump. The second line was irrigated with 10 ml NaCl by his wife daily.At the beginning the adhesive plate was changed every 14 days. Because of skin irritations and pain during the change of the bandage the patient decided at the 10.8.2017 to do no more further changes of the adhesive plate.The adhesive plate was controlled through the transparent plaster and the transparent plaster was changed for the first time on the 20.10.2017 without removing the adhesive plate. The change of the adhesive plate itself was done on the 13.12.2017 without any complications.In this described case there were no complications even after more than 4 months (20 weeks) although there was no change of the adhesive plate during this time.It is suggested to individualize the interval of the change of the adhesive plate for palliative patient even more. Larger studies could give more detailed guidelines for an extend change interval. Thereby the comfort and the safety of the patient should be more important than the economic aspects (less effort and smaller costs because of the extended intervals of change).