Hospitalist Experiences, Practice, Opinions, and knowledge regarding peripherally inserted central catheters: Results of a national survey

Abstract

BACKGROUND A Michigan survey found variation in hospitalist‐reported experience, practice, opinions, and knowledge related to peripherally inserted central catheters (PICCs). Whether these findings reflect a national trend is unknown. OBJECTIVE To investigate self‐reported PICC practice among adult hospitalists in the United States. METHODS Society of Hospital Medicine‐administered, anonymous, Web‐based survey of practicing, adult, non‐Michigan hospitalists. RESULTS Of the 2112 hospitalists who were sent an electronic invitation, 381 completed the online survey (18%). Eighty‐six percent of hospitalists reported having placed a PICC solely for venous access (vs specific indications such as long‐term antibiotics or parenteral nutrition). Eighty‐two percent reported having cared for a patient who specifically requested a PICC. Only 25% of hospitalists reported examining PICCs for evidence of external problems, whereas 57% admitted to having, at least once, forgotten about the presence of a PICC. Only 9% of respondents knew that PICC tip verification was performed primarily to prevent venous thromboembolism. Finally, 42% of participants indicated that 10% to 25% of PICCs placed in their hospitals might be inappropriately placed and/or avoidable. CONCLUSIONS This national survey highlights several potential opportunities to improve hospitalist PICC practices. A research agenda dedicated to this issue is necessary to improve patient safety and hospital‐based practice. Journal of Hospital Medicine 2013;8:635–638. © 2013 Society of Hospital Medicine

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

“…In both a Michigan and a national survey, approximately 1 in 4 hospitalists were not aware of the association between device characteristics such as number of lumens, gauge, or PICC-tip position and risk of complications. 14,15 Thus, use of multilumen PICCs may not be informed by consideration of risks. Finally, no studies have examined both cost and clinical benefits across hospitals in a manner that would lend itself to informing policies.…”

Do Clinicians Know Which of Their Patients Have Central Venous Catheters?

“…One plausible explanation for this finding may be physician unawareness of CVC presence, as suggested by surveys of hospitalist providers (13, 14). Indeed, many electronic systems that track CVC use are often nurse-directed or accessible only to infection preventionists, thus being virtually siloed from treating clinicians.…”

“…In survey-based studies of inpatient providers, nearly one half of all hospitalists stated that they had, at least once, forgotten that their patient had a PICC in situ (13, 14). These findings mirror trends noted with indwelling urinary catheters, in which 1 in 3 physicians was unaware that these devices were present (15).…”

Hospitalists and Their Impact on Quality, Patient Safety, and Satisfaction

“…Deep vein thrombosis (DVT) and bloodstream infections are well-known risks associated with peripherally inserted central catheters (PICCs). 10 Other complications associated with PICCs include superficial thrombophlebitis and mechanical complications. Hospitalists play a major role in making the decision to insert and manage these catheters.…”

“…As an example of hospitalists improving patient safety related to PICCs, one hospitalist group led a patient safety program to define the scope of the work needed to improve practice related to these devices. 10 Specific areas of concern that they identified in the use of PICCs are as follows:…”