Short Term Use of Peripherally Inserted Central Catheters in Michigan Hospitals: Prevalence, Patterns and Outcomes

Background: Peripherally inserted central catheters [PICCs] are often used for venous access in hospitalized patients. Prevalence and outcomes of short-term PICC use (<=5 days) have not been previously described. 

Methods:

Using data from the Michigan Hospital Medicine Safety Consortium (a multi-hospital quality improvement initiative dedicated to preventing adverse events in hospitalized medical patients), the prevalence of PICC use <=5 days in hospitalized medical patients at 47-participating hospitals were examined. Descriptive statistics were used to tabulate indications for PICC use, device characteristics and between-hospital variation in rates of PICC placement. Complications associated with short-term insertion were summarized across all hospitals. Differences between indications and complications associated with PICC use <=5 days vs. >=6 days were examined. Chi-square tests were used for all comparisons, with p< 0.05 considered significant. 

Results:

A total of 10,168 PICCs were available for analysis, of which 2,448 (24.1%) were inserted for short-term use <=5 days (range 1 day to 5 days). The most common listed indications for short term PICC use included difficult access, home antibiotics and medicines requiring central venous access. For short-term use, double lumen devices were most frequently used (58.5%) and most devices were placed by vascular access teams (66.9%). 63.6% of PICCs inserted <=5 days were 5Fr while 99.7% were Power PICCs. Substantial variation in rates of short-term PICC use across hospitals was noted, varying from 6% to 39%. Despite the relatively brief exposure, complications associated with PICC use <=5 days were frequent and included deep vein thrombosis and central line-associated bloodstream infection, among others (Table). Compared to PICCs placed for >=6 days, short-term PICC use was more frequently associated with indications of difficult access and medications requiring central access. Rates and types of complications between short and long-term PICC use also differed significantly.

Conclusions:

Short-term use of PICCs to obtain venous access in hospitalized medical patients is common and not benign. Other venous access devices may be safer and more appropriate in this setting; renewed focus to examine and improve use of PICCs in this fashion is needed. The recently introduced MAGIC guidelines may serve as an important resource in this effort.