Education, Research, and Quality Improvement: Education, Research, and Quality Improvement II |

Criteria Development for Peripherally Inserted Central Venous Catheter Insertion FREE TO VIEW

Aasim Mohammed, MD; Bolanle Gbadamosi, MD; Eric Green, MD
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Mercy Catholic Medical Center, Yeadon, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):631A. doi:10.1016/j.chest.2016.08.723
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SESSION TITLE: Education, Research, and Quality Improvement II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Like all central venous catheters, peripherally inserted central catheters (PICC) are associated with excess morbidity. This can be minimized by using PICC lines only when absolutely needed (e.g. for Total parenteral nutrition or long-term intravenous medications), using the smallest diameter catheter possible, and using the right brachial vein when possible. We are yet to see standard criteria for PICC line insertion. Previous studies have demonstrated less thrombotic event with single lumen PICC. PICC inserted by nurses have been found to be more cost effective and associated with less risk of infection. Left sided catheters have also been associated with more thrombotic event. We examined the PICC utilization in two community teaching hospitals.

METHODS: We performed a retrospective study of all patients admitted to Mercy Fitzgerald and Mercy Philadelphia hospital from October 2012 - October 2013 who had a PICC line placed. For each patient, we performed a targeted chart review and extracted information regarding PICC insertion. Indication for PICC was identified as well as the type (single vs. double lumen), location (right vs. left) and how it was inserted (nurse vs. interventional radiologist). Descriptive statistics were generated using Microsoft Excel.

RESULTS: 446 patients had PICC placement which constituted 2% of the total admissions. PICC lines were placed for poor IV access (237, 53% +- 5%), long-term antibiotics (160, 36% +- 3%), Total parenteral nutrition (47, 11% +- 1%), and chemotherapy (2, 0.4% +- 0.002%). Only 17 (4% +- 0.2%) of patients received a single lumen PICC, the rest received a wider diameter dual lumen PICC. 111 (25% +- 2%) patients had a PICC inserted using the left brachial vein. 71% was placed by Interventional radiologist and 29% by vascular team nurse. 61% of PICC lines were initiated on the floor and 39% in the ICU. No significant differences were seen between the two hospitals.

CONCLUSIONS: More than 50% of the patients who had a PICC placed at the two community teaching hospitals required the PICC for poor peripheral IV access, almost all had wider-diameter dual lumen PICCs placed and a very high percentage were placed by the interventional radiologist. This practice potentially exposes patients to unnecessary and/or added risk and cost from PICC use. Strengths of the study are its multi-center design and evaluation of all patients with PICC insertion. Assuming data can be replicated; targeted interventions to use alternate IV access on patients with poor IV access may reduce PICC-related costs and morbidity. Limitation includes reliance on chart review for indication.

CLINICAL IMPLICATIONS: Having a poor IV access should not an absolute indication for PICC. A right sided single lumen placement of PICC by a nurse should be given priority unless if there is a contraindication to doing so.

DISCLOSURE: The following authors have nothing to disclose: Aasim Mohammed, Bolanle Gbadamosi, Eric Green

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