Background: Catheter-associated DVT (deep vein thrombosis) is a known complication of PICC (peripherally inserted central catheter) placement. In an attempt to reduce our institution’s rate of catheter-associated DVT we devised an intervention to reduce the use of multi-lumen PICCs and use a smaller diameter of PICCs.

Methods: A two-part intervention was conducted with 1) educational sessions for all medical residents and hospitalists and 2) change in the EMR order for PICCs to require consultation with IR (interventional radiology) and to set the default request to single lumen catheter. Data was collected by chart review for 9 months pre- and post-intervention on all PICC and midline catheters placed at our institution. Data was collected on midline catheters in addition to PICCs because they represent an alternative catheter to PICCs. Data elements captured included catheter diameter, number of lumens, and occurrence of catheter-associated DVT. Comparisons were analyzed using two sample test of proportions.

Results: Pre-intervention (December 2018-August 2019) there were 1085 total PICC and midline catheters placed (958 PICC and 127 midline). Post-intervention (September 2019-May 2020) there were 993 total PICC and midline catheters placed (850 PICC and 143 midline). The proportion of double lumen PICCs decreased from 61% to 28% (p<0.00001) and the proportion of 5 French PICCs decreased from 29% to 5%. The total number of PICC-associated DVT events decreased from 14 in the pre-intervention period to 4 in the post-intervention period. This corresponds to a decrease in DVT events from 1.5% to 0.5% of all PICCs placed (p=0.034). Of note, there were also 4 DVT events associated with midlines (3% of all midlines) in the pre-intervention period and 2 (1.4% of all midlines) in the post-intervention period.

Conclusions: After implementation of the educational program and change in the EMR order to promote ordering of smaller, single lumen PICCs, there was a significant decrease in proportion of double lumen and 5 French PICCs placed. There was a concurrent significant decrease in proportion of PICCs that were complicated by catheter-associated DVT, suggesting that reducing the number of large and multi-lumen PICCs helps reduce complications such as catheter-associated DVT. Additionally, there was a higher proportion of midlines placed in the post intervention period but they had similar to higher rates of DVT when compared with PICCs, providing an opportunity for further intervention and study of midline-associated DVT. Further study may also focus on other factors that contribute to or protect from development of catheter-associated DVT.

IMAGE 1: Single vs Double Lumen

IMAGE 2: PICC-associated DVT