Dwell time is a critical factor in maximizing the lifespan of vascular access devices. It refers to the duration a catheter can remain safely in place before requiring removal or replacement. Understanding dwell time helps healthcare providers select the most appropriate device for a patient’s needs.
Dwell Times for Different Vascular Access Devices
- Short Peripheral Intravenous Catheters (SPIVCs)
- SPIVCs typically have the shortest dwell times, ranging from 2 to 4 days. These devices are suitable for short-term use but may require frequent replacement.
Extended Dwell Catheters (EDCs)
- EDCs demonstrate significantly longer dwell times compared to standard ultrasound-guided IVs:
- Median dwell time: 5 days for EDCs vs 3 days for standard USIVs
- EDCs show improved survival with a hazard ratio of 0.70 when adjusted for various factors
- Midline catheters offer even longer dwell times:
- Average dwell time: 7 to 16 days
- Can remain in place for up to 30 days
- PICC lines can remain in place for 30 days or greater, with reported durations ranging from weeks to 6 months, and in some cases, up to 1 year if no complications arise.
- However, dwell times exceeding 14–35 days may increase the risk of complications such as catheter-associated bloodstream infections
Ports
- Implantable ports are designed for long-term use, typically exceeding 30 days, and are ideal for patients requiring vascular access for extended periods (e.g., chemotherapy).
- Ports can remain functional for months to years if properly maintained.
Factors Affecting Dwell Time
Several factors can influence the dwell time of vascular access devices:
- Catheter material: Silicone and polyurethane catheters, especially those with a high ratio of soft polymers, can reduce vein trauma and increase tolerance.
- Insertion site: The location of catheter placement can affect dwell time. For example, catheters placed in shallow vessels (<0.4 cm) tend to survive longer.
- Patient characteristics: Older age and male gender are associated with decreased risk of catheter failure.
- Insertion technique: Ultrasound-guided insertion may lead to longer dwell times for some devices.
Maximizing Device Lifespan
To optimize the longevity of vascular access devices:
- Select the appropriate device based on the expected duration of treatment.
- Use ultrasound guidance for insertion when appropriate.
- Consider patient-specific factors such as age, gender, and vein characteristics.
- Implement proper care and maintenance practices to prevent complications.
- Regularly assess the need for the device and remove it as soon as it’s no longer required.
By understanding dwell time and its influencing factors, healthcare providers can make informed decisions to maximize vascular device lifespan, improve patient comfort, and reduce the need for frequent replacements.
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References:
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
Endovascular Today. (2022, July 12) Access Vascular’s HydroMid Midline Catheter Shows Increased Dwell Times in Retrospective Data Review. https://evtoday.com/news/access-vasculars-hydromid-midline-catheter-shows-increased-dwell-times-in-retrospective-data-review
Hull University Teaching hospitals, (2023, June 2) Caring for your Peripherally Inserted Central Catheter (PICC) Line for Parenteral Nutrition or Intravenous fluids. https://www.hey.nhs.uk/patient-leaflet/caring-peripherally-inserted-central-catheter-picc-line/
Mielke, D. et al., (2020, January 22) Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7447660/
Fung, C. et al., (2021, May 6) Extended dwell and standard ultrasound guided peripheral intravenous catheters: Comparison of durability and reliability. https://pmc.ncbi.nlm.nih.gov/articles/PMC8364880/