Which situation increases the risk that a PICC could become dislodged?

October 2, 2025 •

4 min read

Studies show that accidental dislodgement is one of the most common complications associated with Peripherally Inserted Central Catheters (PICCs). Understanding which situation increases the risk that a PICC could become dislodged is crucial for patients, caregivers, and healthcare providers to ensure device integrity and prevent serious health issues.

Quick Summary

Catheter migration and dislodgement can result from patient-related factors, mechanical force, and issues with securement. Risk increases with aggressive coughing or vomiting, inadequate dressing security, vigorous arm movement, and during patient transfers. Certain vulnerable populations, such as confused, pediatric, or critically ill patients, are also at higher risk of displacement.

Key Points

Vigorous Movement: Intense arm movements, heavy lifting, or patient transfers can cause tension that pulls on the PICC line, leading to dislodgement.
Increased Intrathoracic Pressure: Situations like severe coughing, vomiting, and mechanical ventilation can create internal pressure changes that can displace the catheter tip.
Inadequate Securement: A loose, wet, or soiled dressing and improper use of a stabilization device are critical risk factors for accidental dislodgement.
Vulnerable Patients: Pediatric, confused, or critically ill patients may unintentionally manipulate or pull on their lines, increasing the risk of dislodgement.
Improper Site Selection: Placing the PICC near a major flexion point, such as the elbow, can lead to repeated stress on the catheter and eventual dislodgement.

A peripherally inserted central catheter, or PICC line, is a thin, flexible tube inserted into a vein, typically in the upper arm. It is used to deliver long-term medications, intravenous fluids, and nutrition. While offering many advantages over traditional IVs, PICCs are susceptible to dislodgement or migration, where the catheter moves from its intended position. This can lead to serious complications, including delays in treatment, vein damage, or infection. Identifying the contributing factors is the first step toward effective prevention.

Factors Related to Increased Force

Mechanical forces, both external and internal, are major culprits behind PICC dislodgement. These forces can cause the catheter to be pulled out of position or its tip to migrate internally.

Patient Movement and Mechanical Strain

Vigorous arm movement: Repetitive or sudden forceful movements of the arm where the PICC is inserted can create tension on the catheter, pulling it out of the insertion site. Examples include vacuuming, bowling, or lifting objects heavier than 10 pounds.
Patient transfers: Moving a patient from a bed to a stretcher, a wheelchair, or during repositioning can inadvertently snag or pull the line if care is not taken to manage the tubing.
Inadequate securement: If the catheter is not properly secured with an adhesive stabilization device or sutures, normal patient movement, or even catching the line on bedding, can cause it to pull out.

Increased Intrathoracic and Intra-Abdominal Pressure

Events that cause a sudden increase in pressure inside the chest or abdomen can force the catheter tip to migrate. The flexible nature of PICC lines makes them susceptible to this.

Vigorous coughing: Intense coughing episodes significantly increase intrathoracic pressure, which is a known risk factor for PICC migration.
Severe vomiting: Similar to coughing, severe vomiting can generate enough force to dislodge the catheter tip.
Mechanical ventilation: Patients on mechanical ventilation experience continuous pressure changes, which can also contribute to PICC migration.

Securement and Maintenance Failures

Proper maintenance is essential for keeping a PICC line in place. Failures in securement or dressing care create opportunities for dislodgement.

Dressing compromise: Dressings that become loose, soiled, or wet are no longer effective and increase the risk of dislodgement and infection. Water from showering, or excessive sweating, can weaken the dressing's adhesive.
Improper fixation: Failure to use a proper stabilization device or correctly suture the catheter can leave the line vulnerable to accidental pulls.
Improper insertion site: Placing the PICC too close to a major joint, like the elbow, can lead to tension and dislodgement as the patient moves their arm.

Patient-Specific Factors and Improper Practices

Individual patient characteristics and certain hospital practices also play a role in the risk of dislodgement.

Vulnerable Patient Populations

Pediatric patients: Children, especially infants, are at higher risk due to their smaller size, increased activity, and potential for accidental or intentional manipulation.
Confused or elderly patients: Patients who are cognitively impaired, disoriented, or simply lack awareness of the PICC can unintentionally pull or manipulate the line.
Intensive Care Unit (ICU) stay: Studies show that patients in the ICU are at a higher risk of unexpected PICC removal, which may be related to their critical status and increased medical interventions.

High-Pressure Events and Incorrect Practices

Power injection: Using high-pressure injections, such as for contrast-enhanced CT scans, can cause a sudden displacement of the catheter tip.
Removing other lines: If another central venous catheter is removed from the same vein or a nearby one, it can inadvertently snag and displace the PICC line.

Comparison of Risk Factors


Situation	High-Risk of Dislodgement	Low-Risk of Dislodgement
Patient Movement	Active, vigorous exercise (e.g., contact sports)	Gentle, routine daily activities
Dressing Condition	Loose, wet, or soiled dressing	Clean, dry, and securely affixed dressing
Securing Device	Inadequate fixation or absence of a securing device	Use of a specialized adhesive stabilization device
Patient Condition	Confused, disoriented, or young pediatric patients	Alert, compliant adult patients
Insertion Site	Near a major flexion point like the elbow	Basilic vein or other low-movement site
Medical Events	Frequent coughing, vomiting, or mechanical ventilation	Stable vital signs without intense coughing or emesis

Preventive Measures to Minimize Dislodgement

Minimizing the risk of dislodgement requires a combination of clinical vigilance and proper patient care. The following measures can significantly reduce complications.

Regular Site Assessment: Routinely check the insertion site for signs of infection or a loose dressing. Measure the external length of the catheter to detect any migration.
Proper Securement: Ensure a suitable stabilization device, and a sterile, intact dressing is always in place. Change dressings immediately if they become wet, soiled, or loose.
Patient Education: Educate patients and caregivers on necessary precautions, including activity limitations and how to protect the line.
Use Protective Covers: During showers or other activities, use a waterproof cover or sleeve to keep the dressing and catheter dry.
Avoid High-Risk Activities: Patients should avoid heavy lifting, contact sports, and repetitive arm movements. They should also be careful with transfers and avoid snagging the tubing.

Conclusion

While a PICC line provides a safe and effective means for long-term treatment, it is not without risks. Dislodgement is a significant concern that can be caused by a variety of factors, from patient movement and increased intrathoracic pressure to improper securement and inadequate patient education. By understanding which situation increases the risk that a PICC could become dislodged and implementing consistent preventative measures, patients and healthcare providers can work together to minimize complications and ensure the continued efficacy of the catheter. Vigilance and proper care are the most effective tools for maintaining PICC line integrity and promoting patient safety.

Frequently Asked Questions

While multiple factors contribute, the most significant risk comes from mechanical forces exerted on the line, such as accidental pulling during vigorous arm movement, patient transfers, or due to a compromised securement device.

Yes. Severe or frequent episodes of coughing and vomiting can significantly increase the pressure within the chest cavity. This change in intrathoracic pressure can cause the flexible PICC tip to migrate from its central position.

Dressings should typically be changed at least once per week, or immediately if they become wet, soiled, or start to peel away from the skin. A secure, dry, and intact dressing is vital for preventing infection and dislodgement.

Yes, some patient populations are at higher risk. This includes pediatric patients, who are more active and may manipulate the line, and confused or disoriented elderly patients who may pull at the catheter unintentionally.

If you notice a change in the external length of the catheter, experience pain, or have difficulty with flushing, you should immediately secure the line and contact your healthcare provider. Do not attempt to push the line back in, as this can introduce infection.

It is important to avoid strenuous or repetitive exercises that use the affected arm, as this increases the risk of dislodgement. Gentle walking and light stretching are often acceptable, but you should always follow your doctor's specific recommendations.

You should use a waterproof cover, such as a specialized PICC sleeve or securely taped plastic wrap, to prevent the dressing from getting wet. You must avoid baths, swimming, and hot tubs where the line would be submerged.