Background: Urinary catheters, vascular catheters, and wounds such as pressure injuries are often hidden from view under gowns and sheets – out of sight, out of mind – contributing to prolonged catheter use, infections, delayed interventions, and diagnostic errors for symptoms (e.g., fever, delirium) related to catheters and wounds. We developed and pilot tested a [...]

Background: Guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated use is 5 or fewer days.  However, short-term PICC use is common in hospitals. We sought to identify patient-, provider- and device-characteristics associated with short-term PICC use. Methods: Between January 2014 and June 2016, trained abstractors at each of 51 Michigan [...]

Background: Multi-lumen (ML) peripherally inserted central catheters (PICCs) are associated with increased risk of central line associated blood stream infection (CLABSI), venous thromboembolism (VTE) and increased cost compared to single lumen (SL) PICCs. Current guidelines recommend minimizing the number of PICC lumens. However, there is a paucity of literature to guide the selection of SL [...]

Background: Central line-associated bloodstream infection (CLABSI) is a morbid and potentially lethal complication. National policies related to CLABSI mandate public reporting of this adverse event, with hospitals receiving penalties based on their CLABSI rates. Contemporary data suggest that peripherally inserted central catheters (PICCs) placed outside critical care settings are a large contributor to hospital CLABSI [...]

Background: Peripherally inserted central catheters (PICCs) are associated with an increased risk of central line-associated bloodstream infection (CLABSI) and venous thromboembolism (VTE). Catheters that are coated or impregnated with antimicrobial and/or antithrombotic agents have been developed to prevent these complications. However, their effectiveness in preventing CLABSI and VTE is unclear. Using data from a large [...]

Background: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their engagement influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium on PICCs placed in hospitalized medical patients [...]

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 [...]

Case Presentation: A 58 year-old man with a past medical history of Chronic Obstructive Pulmonary Disease, poorly controlled Diabetes Mellitus (HbA1C 9.5%), and Hepatitis C with liver cirrhosis, presented with acute respiratory distress syndrome due to bibasilar community acquired pneumonia, eventually requiring extracorporeal membrane oxygenation. His hospital course was further complicated by empyema requiring placement [...]

Case Presentation: A 29 year old female with past medical history significant for hyperemesis gravidarum requiring total parenteral nutrition (TPN) presented to the Emergency Department (ED) with chest pain. She had been having intermittent chest pain for the last 3-4 years, which she had always attributed to the scar from her infusion port. An infusion [...]

Background: Central line associated bloodstream infection (CLABSI) is the 8th leading cause of death in the United States, causing 100,000 deaths annually. Each CLABSI costs about $56,000 per patient and increases length of hospital stay by an average of 3 weeks. Femoral lines have been shown to have the highest risk of infection compared to [...]