Background: Peripherally inserted central catheters (PICCs) are an increasingly common vascular access device, with more than 4000 devices placed per year at our institution. Though these devices are generally considered safe and effective, they are not without risks, particularly of catheter-related infection and thrombosis. These risks increase exponentially with increasing number of lumens. At our institution, multilumen catheters were being placed more frequently than single lumen catheters, despite observational data suggesting this was unnecessary. Our quality improvement group sought to decrease the relative number of multilumen catheters placed in order to enhance patient safety.
Methods: A multidisciplinary team, led by members from Infectious Disease, Hospital Internal Medicine, and Infusion Therapy, reviewed the literature, gathered data, applied quality improvement tools, and developed multi-faceted interventions. The primary intervention was extensive modification to the electronic order system for PICCs lines. Additional interventions included development of an on-call physician resource for vascular access questions, increased provider education, and emphasis on communication and collaboration between the PICC nurses and the care teams.
Results: In the six month period prior to the interventions, the average relative proportions of inserted PICCs were 30.4% single lumen, 37.2% double lumen, and 32.4% triple lumen. Six months post- intervention, the lumen proportions shifted to 46.3% single, 32.2% double, and 21.5% triple. These effects were sustained, and at fifteen months post-intervention, the lumen proportions remained improved at 44.7 % single, 37.1% double, and 18.2% triple lumen.
Conclusions: Changes to the electronic order entry system are an effective “nudge” to achieve sustained improvements in provider ordering habits. On-call vascular access experts, provider education, and enhanced collaboration between the PICC nurses and care teams also contributed to the success of our interventions and the sustainment of the improvements.
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