CE Article: Nursing-Placed Midline Catheters and Ultrasound-Guided Peripheral IVs Promote More Appropriate Catheter SelectionCE
Popularity of PICCs and concerns about their overuse have increased in recent years. A VAT was established at a large, tertiary care hospital to meet growing PICC demand. MC and USGPIV placement was eventually added to the VAT’s capabilities. VAT-placed MC and USGPIV reduced hospital-wide PICC use.
Purpose: Deep vein thrombosis (DVT) and central line-associated bloodstream infection (CLABSI) are serious complications of peripherally inserted central catheters (PICCs). Because of these risks, midline catheters (MCs) and ultrasound-guided peripheral intravenous catheters (USGPIVs) were added to the capabilities of the host institution’s nursing-based venous access team (VAT), which operates under the direction of Interventional Radiology (IR). This report evaluates this effort to reduce PICCs and MCs through appropriate patient-centered device choice.
Materials: A retrospective analysis of PICCs, MCs, and USGPIVs placed in inpatients in a large tertiary care academic hospital was conducted, using the VAT’s record supplemented with data from the IR quality assurance database. Analysis of hospital records of upper extremity DVT and CLABSI was also performed.
Results: The VAT documented 33,113 PICC, 12,135 MC, and 14,300 USGPIV placements from September 2001 to March 2018. From the peak of PICC placements in 2006 to the peak of MCs in 2010, PICCs decreased 23% (P < 0.01), while MCs increased 93% (P < 0.001). Following full implementation of USGPIV in January 2016, MCs decreased 34% from 2015 to 2016 (P < 0.01) with no concurrent decrease in PICCs (P = 0.72). CLABSI rates per 1000 central venous catheter days decreased from 1.5 to 0.44 (P < 0.01), coinciding with an unrelated CLABSI reduction initiative. No interpretable trends in DVT counts were discovered.
Conclusions: Appropriate use of MCs and USGPIVs by an IR-supported VAT significantly decreased PICCs and MCs, respectively.Highlights
Abstract
Number of PICCs placed by nursing-based venous access team and Interventional Radiology. VAT and total PICC data incomplete for FY2007. FY = fiscal year; PICC = peripherally inserted central catheter; VAT = venous access team.
Annual total VAT catheters by type. VAT MC data incomplete for 2005, 2006, and 2007; VAT PICC data incomplete for 2007. 2018 is partial year data. MC = midline catheter; PICC = peripherally inserted central catheter; VAT = venous access team.
Annual proportion of VAT catheters by type. VAT MC data incomplete for 2005, 2006, and 2007; VAT PICC data incomplete for 2007. 2018 is partial year data. MC = midline catheter; PICC = peripherally inserted central catheter; VAT = venous access team.
CLABSI rates per 1000 catheter-days and DU ratios (CVC per patient-day) by month. CLABSI = central line-associated bloodstream infection; CVC = central venous catheter; DU = device utilization.
DVT rate per 1000 patient-days by month. DVT = deep vein thrombosis.
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