Background: The number of peripherally inserted central catheter (PICC) lumens has been associated with thrombotic and infectious complications. Policies that limit use of multi-lumen PICCs may improve safety and reduce cost. In this simulation-based study, our objective was to estimate the clinical and cost tradeoffs of policies that limit use of multi-lumen PICCs.
Methods: Simulation-based analysis examining costs associated with single- and multi-lumen PICCs. Model inputs including prevalence of device use, risk and rates of complications, and costs associated with maintenance of single- and multi-lumen PICCs were obtained from an ongoing multi-hospital quality collaborative and published literature. Multi-way sensitivity analyses to assess robustness of findings were performed. Cost savings and reduction in central line-associated bloodstream infection (CLABSI) and deep vein thrombosis (DVT) events from institution of a single-lumen PICC default policy with corresponding 95% confidence intervals (CI) were calculated.
Results: According to our simulation, a hospital that places 1,000 PICCs per year (25% of which are single-lumen and 50% multi-lumen) experiences annual PICC-related maintenance and complication costs of $1,407,451 (95% CI $1,215,379-$1,627,500). Every 5% increase in single-lumen PICCs in such facilities is estimated to prevent 1.5 PICC-related CLABSIs and 0.5 PICC-related DVTs, while saving $12,500 in maintenance costs. Thus, savings of $35,500 from reduction in complication and maintenance costs for each 5% increase in single-lumen PICC use is expected. Moving from 25% to 50% single-lumen PICC utilization would result in total savings of $179,251 (95%CI: $105,763-$275,026) per year. Regardless of baseline PICC use, results suggest that a single-lumen default PICC policy would be associated with approximately 13% cost-savings. Findings remained robust in multi-way sensitivity analyses and scenarios incorporating variation in use, cost and risk of complications. Some limitations of our approach include the fact that a catheter dwell of one week was assumed for all calculations and that neither provider skill nor patient complexity were considered.
Conclusions: Hospital policies that limit the number of PICC lumens can enhance patient safety and reduce healthcare costs. Given the penalties associated with hospital-acquired conditions such as CLABSI, savings from this approach can be substantial. Studies measuring intended and unintended consequences of this approach followed by rapid adoption of such policies are necessary.