David Andrew Bozaan, MD*1;Matthew Tupps, PharmD2;Adamo Brancaccio, PharmD2;Patrick Arnold, PharmD2;Susan Friebe, MSN, RN, CRNI2;Deanna Skicki, RN2;Dr. David Paje, MD, MPH1;Alexis Nicole Lopez, M.D.2 and Vineet Chopra, MD, MSc3, (1)University of Michigan Health System, Ann Arbor, MI, (2)University of Michigan, Ann Arbor, MI, (3)VA Ann Arbor Healthcare System, Ann Arbor, MI

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 143

Categories: Innovations Abstracts, Quality Improvement

Keywords: , , ,

Background: Multi-lumen (ML) peripherally inserted central catheters (PICCs) are associated with increased risk of central line associated blood stream infection (CLABSI), venous thromboembolism (VTE) and increased cost compared to single lumen (SL) PICCs. Current guidelines recommend minimizing the number of PICC lumens. However, there is a paucity of literature to guide the selection of SL versus ML PICCs.

Purpose: Our goal was to create a standard for when to use SL versus ML PICCs and ultimately decrease the placement of ML PICCs in clinical practice. We also sought to improve communication among ordering providers, vascular access team (VAST) nurses and clinical pharmacists by creating a multi-disciplinary team approach to device selection.   

Description: Using a multidisciplinary team approach, we identified four major indications for ML PICCs: (1) continuous vesicant or irritant chemotherapy with additional lumen needs, (2) need for vasopressors, (3) need for simultaneous administration of multiple incompatible medications and (4) TPN plus additional lumen needs. We conducted an educational program for hospitalist physicians, clinical pharmacists and VAST nurses where we reviewed the current literature and published guidelines regarding PICC lumens.  We then described our clinical innovation and introduced our list of approved indications for ML PICCs. We requested ordering physicians to only select ML PICCs in accordance with our approved indications.  If a ML PICC was not clearly indicated, the VAST nurse contacted the clinical pharmacist for additional review.  The clinical pharmacist then reviewed active and planned medications with the ordering provider and recommended alternative treatments or retiming of incompatible medications to facilitate placement of a SL PICC. When clinically appropriate, the ordering physician adjusted the ML PICC order to a SL PICC order.  The clinical pharmacist notified the VAST nurse regarding the ultimate decision.

Conclusions: We found that the use of SL PICCs increased from 63% to 93% with a proportional decrease in the placement of ML PICCs. There were no instances where the SL PICC was inadequate to meet a patients vascular access needs and we continue to evaluate for this potential complication. We anticipate that the expansion of our multi-disciplinary team approach to PICC device selection and our strategy of using SL PICCs as default while limiting the use of ML PICCs to clearly defined indications will reduce the incidence of CLABSI and VTE as well as decrease overall health care cost.

To cite this abstract:

Bozaan, DA; Tupps, M; Brancaccio, A; Arnold, P; Friebe, S; Skicki, D; Paje, D; Lopez, AN; Chopra, V . LESS LUMENS = LESS RISK. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 143. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/less-lumens-less-risk/. Accessed February 24, 2020.

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