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Original Research: Procedures |

Reduction of Peripherally Inserted Central Catheter-Associated DVTPeripherally Inserted Central Catheters and DVT

R. Scott Evans, PhD; Jamie H. Sharp, RN, VA-BC; Lorraine H. Linford, RN, BS, CNSC; James F. Lloyd, BS; Scott C. Woller, MD; Scott M. Stevens, MD; C. Gregory Elliott, MD, FCCP; Jacob S. Tripp, PhD; Spencer S. Jones, PhD; Lindell K. Weaver, MD, FCCP
Author and Funding Information

From Medical Informatics (Drs Evans and Tripp and Mr Lloyd), Intermountain Healthcare; Biomedical Informatics (Dr Evans), and the Department of Medicine (Drs Woller, Stevens, Elliott, and Weaver), University of Utah School of Medicine; Nutrition Support Service/PICC Team (Mss Sharp and Linford), and Department of Medicine (Drs Woller, Stevens, Elliott, and Weaver), Intermountain Medical Center; RAND Corporation (Dr Jones); and Hyperbaric Medicine (Dr Weaver), Intermountain Medical Center and LDS Hospital, Salt Lake City, UT.

Correspondence to: R. Scott Evans, PhD, Medical Informatics, LDS Hospital, 8th Ave and C St, Salt Lake City, UT 84143; e-mail: rscott.evans@imail.org.


For editorial comment see page 589

Funding/Support: This work was a quality improvement project funded by Intermountain Healthcare.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):627-633. doi:10.1378/chest.12-0923
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Background:  As peripherally inserted central catheter (PICC) use has increased, so has the upper extremity DVT rate. PICC diameter may pose the most modifiable risk for PICC-associated DVT.

Methods:  A 3-year, prospective, observational study of all PICC insertions by a specially trained and certified team using a consistent and replicable approach was conducted at a 456-bed, level I trauma and tertiary referral hospital during January 1, 2008, through December 31, 2010. An intensified effort by the PICC team in 2010 was introduced to discuss and reach interdisciplinary consensus on the need for each lumen of the PICC and a change to smaller diameter 5F triple-lumen PICC.

Results:  Significantly more 4F single-lumen PICCs were used during 2010 (n = 470) compared with 2008 and 2009 (n = 338, 382; P < .0001). DVT rates were similar with the use of 5F triple-lumen PICCs in 2010 as 5F double-lumen PICCs and lower rates than 6F triple-lumen catheters used in 2008 and 2009. The PICC-associated DVT rate was significantly lower (1.9% vs 3.0%, P < .04) in 2010 compared with 2008 and 2009. The cost and length of stay attributable to PICC-associated DVT were $15,973 and 4.6 days.

Conclusions:  A significant increase in the use of single-lumen PICCs in addition to the institutional adoption of smaller 5F triple-lumen PICCs was associated with a significant decrease in the rate of PICC-associated DVT.

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