Background: Despite growing use, limited data regarding “real world” use of peripherally inserted central catheters (PICCs) exist. Available evidence is informed by single-center experiences or studies of specific populations (e.g., cancer or critically ill patients). More information on PICC use and outcomes in general medical hospitalized patients is needed.
Methods: Between January and November 2014, 10 hospitals from the Michigan Hospital Medicine Safety (HMS) consortium participated in a prospective, observational pilot study to quantify and describe PICC use and outcomes. Every 2 weeks, trained abstractors collected data on 18 patients who underwent PICC insertion at a participating hospital were randomly selected. Baseline data including demographics, medication use, comorbidities, indication for PICC use and PICC characteristics (e.g., gauge, number of lumens, and coating) were collected. Patients were followed for 60 days or until PICC removal. Outcomes of interest, including major complications (e.g., symptomatic proximal upper extremity deep vein thrombosis [UEDVT], pulmonary embolism [PE], and central line-associated bloodstream infection [CLABSI]), and minor complications (e.g., exit site infection, mechanical complications, and catheter-related thrombosis) were identified by medical record review and by phone calls to patients.
Results: Of 2,570 unique PICCs included in the analysis, 1,846 (72%) were inserted by vascular access nurses and 529 (21%) by interventional radiologists. POWER-devices, specialized PICCs that can withstand injections from a contrast injector, were used in 2,492 (97%) PICC insertions. Substantial variation in the indication for PICC use across sites was noted (p<0.0001) (Figure 1). Similarly, PICC characteristics (e.g., number of lumens and gauge) differed significantly across participating hospitals (p<0.0001). Variation in PICC dwell time across hospitals was also observed (mean, 14.7 days; SD 13.2 days) with more than 50% of PICCs being removed within 14 days of insertion (Table 1).
A PICC-related complication occurred in 492 (17.9%) cases. Across all hospitals, catheter-thrombosis was the most frequent complication and occurred in 271 (10.5%) cases, of which 86% required instillation of tissue plasminogen activator. Thrombotic complications outside the catheter, including DVT and PE, occurred in 131 (5.1%) and were more frequent in critically ill patients compared to general medical patients (5.4% vs. 3.6%). Although CLABSI was only documented in 30 (1.2%) cases, the PICC was removed for suspected CLABSI in 145 patients (5.6%).
Conclusions: Significant variation in indication, device characteristics, dwell time and adverse events related to PICC use in hospitalized medical patients exists. Quality improvement efforts directed to improving indication and appropriateness of PICC use may substantially improve the safety of hospitalized medical patients.
Funding: Blue Cross / Blue Shield of Michigan supported data collection at each participating site, database generation and maintenance, but had no role in study concept, interpretation of findings, or in the preparation, review or final approval of the abstract.