Peripherally inserted central catheters (PICCs) are commonly inserted/ordered by hospitalists for venous access, long‐term therapies, and infusion of total parenteral nutrition, Despite these salient roles, little is known about PICC use in hospitalized patients. To understand hospitalist practice related to PICC, a Web‐based survey of a convenience sample of hospitalists in 4 health care systems across Michigan was designed.
We conducted an online survey to assess hospitalist experience, practice, opinions, and knowledge related to PICCs. A convenience sample of hospitalists (n = 227) was obtained from 4 large health care systems that participate in the Hospital Medicine Safety (HMS) Consortium, a Blue Cross/Blue Shield of Michigan–funded collaborative quality initiative. Individuals engaged in research, quality improvement, or leadership at HMS sites were invited to serve as site principal investigators (PIs). Participation in the survey was solicited via e‐mail invitations from site PIs to hospitalists within their group. As an incentive to increase participation, a $10.00 electronic gift card was offered to respondents who successfully completed the survey. The survey was made available for 5 weeks to maximize recruitment to the study, and all responses were collected anonymously.
The overall response rate was 63% (n = 144). Hospitalists believed that, compared with central venous catheters, PICCs were safer to insert (81%) and preferred by patients (74%). Although 84% of respondents felt that placing a PICC solely to obtain venous access was appropriate, 47% of hospitalists indicated that 10%–25% of PICCs inserted in their hospitals might represent inappropriate placement. Hospitalist knowledge regarding PICC‐related complications was poor for PICC‐related venous thromboembolism. For instance, only 4% of hospitalists recognized that PICC‐tip verification was important in preventing thrombosis. Furthermore, hospitalist practice related to PICCs demonstrated several concerns. For example, 1 in 3 hospitalists stated they never examined PICCs for externally evident problems such as exit‐site infection; the majority of surveyed hospitalists (48%) stated that once a PICC was inserted, they did not remove it until a patient was ready for discharge, and 51% admitted that, at least once, they had “forgotten” that their patient had a PICC.
Significant variation in hospitalist experiences, practice, opinion, and knowledge related to PICCs exists. Because these devices are often associated with important complications, studies examining the impact of this variation are necessary. Until such evidence is available, health systems should consider developing mechanisms to monitor PICC use.