A quality improvement project to decrease utilization of multilumen peripherally inserted central catheters

Sween, Jennifer Kleinman; Lowrie, Angela; Kirmse, Jane; Laughlin, Rena Kane; Wodziak, Brooke; Sampathkumar, Priya

doi:10.1017/ice.2020.411

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…The emergence of appropriateness criteria to guide vascular access device use, greater awareness of PICC-related complications, and financial penalties associated with CLABSI have spurred the use of midlines in hospitalized patients . Numerous studies have reported a decrease in PICC use and complications by substituting midlines in hospitalized patients …”

Section: Introductionmentioning

confidence: 99%

“…8,9 Numerous studies have reported a decrease in PICC use and complications by substituting midlines in hospitalized patients. [1][2][3][10][11][12][13][14] As use of midlines has grown, concerns regarding premature failure and major complications from these devices have also emerged. 15 For example, several observational studies have suggested that midline complications, including infection, thrombosis and failure, may rival or outnumber those from PICCs.…”

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confidence: 99%

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Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

et al. 2022

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IMPORTANCE Peripherally inserted central catheters (PICCs) and midlines are frequently used for short-term venous access; whether one is safer than the other in this setting has not been adequately reported.OBJECTIVE To compare outcomes between patients who had a PICC vs midline placed for the indication of difficult vascular access or antibiotic therapy for 30 or fewer days. DESIGN, SETTING, AND PARTICIPANTSThis cohort study analyzed data from a multihospital registry including patients admitted to a participating site from December 2017 through January 2020 who had a PICC or midline placement for the indications of difficult venous access or intravenous antibiotic therapy prescribed for 30 or fewer days. Data were analyzed from October 2020 to March 2021. EXPOSURES PICC and midline placement.MAIN OUTCOMES AND MEASURES Major complications, including a composite of symptomatic catheter-associated deep vein thrombosis (DVT), catheter-related bloodstream infection, and catheter occlusion. Logistic regression and Cox proportional hazards regression models (taking into account catheter dwell) were used to estimate risk for major complications, adjusting for patient and device characteristics and the clustered nature of the data. Sensitivity analyses limiting analyses to 10 days of device dwell were performed.RESULTS Data on 10 863 patients, 5758 with PICCs and 5105 with midlines (median [IQR] age of device recipients, 64.8 [53.4-75.4] years; 5741 [52.8%] were female), were included. After adjusting for patient characteristics, comorbidities, catheter lumens, and dwell time in logit models, patients who received PICCs had a greater risk of developing a major complication compared with those who received midlines (odds ratio, 1.99; 95% CI, 1.61-2.47). Reduction in complications stemmed from lower rates of occlusion (2.1% vs 7.0%; P < .001) and bloodstream infection (0.4% vs 1.6%; P < .001) in midlines vs PICCs; no significant difference in the risk of DVT between PICCs and midlines was observed. In time-to-event models, similar outcomes for bloodstream infection and catheter occlusion were noted; however, the risk of DVT events was lower in patients who received PICCs vs midlines (hazard ratio, 0.53; 95% CI, 0.38-0.74). Results were robust to sensitivity analyses. CONCLUSIONS AND RELEVANCEIn this cohort study among patients with placement of midline catheters vs PICCs for short-term indications, midlines were associated with a lower risk of bloodstream infection and occlusion compared with PICCs. Whether DVT risk is similar or greater with midlines compared with PICCs for short-term use is unclear. Randomized clinical trials comparing these devices for this indication are needed.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

et al. 2022

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“…Daily assessment of invasive devices for continued need and early detection of complications enhances patient safety. Implementation studies of multimodal bundles, including daily prompts of device necessity, have achieved reduction in utilization of IUCs (Gazarin et al, 2020;Giles et al, 2020;Kuriyama et al, 2019;Niederhauser et al, 2019;Schweiger et al, 2020), CVADs (Kara et al, 2016;Kleinman Sween et al, 2021;Walz et al, 2015;Xiong & Chen, 2018), CVADs and IUCs (Chandramohan et al, 2018;Kaminski et al, 2021;Mena Lora et al, 2020), IUCs and PIVCs (Laan et al, 2020), andPIVCs (Egerton-Warburton et al, 2019;Mestre et al, 2013;Yagnik et al, 2017). Interventions that employ education, daily reminders, and automated stop-orders demonstrate greater clinician awareness of device use and prompt removal of unnecessary devices, with subsequent reductions in complications and infections (Kleinman Sween et al, 2021;Meddings et al, 2020;Mitchell et al, 2019;Yu et al, 2020), but continued vigilance is crucial (Chandramohan et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

Ray‐Barruel¹

2021

Vasc Acc

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Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care, and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.

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Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days

Beville

Heipel

Vanhoozer

et al. 2021

Curr Infect Dis Rep

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A quality improvement project to decrease utilization of multilumen peripherally inserted central catheters

Cited by 4 publications

References 9 publications

Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications

I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days

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