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

Abstract

BACKGROUND The number of peripherally inserted central catheter (PICC) lumens is associated with thrombotic and infectious complications. Because multilumen PICCs are not necessary in all patients, policies that limit their use may improve safety and cost. OBJECTIVE To design a simulation-based analysis to estimate outcomes and cost associated with a policy that encourages single-lumen PICC use. METHODS Model inputs, including risk of complications and costs associated with single- and multilumen PICCs, were obtained from available literature and a multihospital collaborative quality improvement project. Cost savings and reduction in central line-associated bloodstream infection and deep vein thrombosis events from institution of a single-lumen PICC default policy were reported. RESULTS According to our model, a hospital that places 1,000 PICCs per year (25% of which are single-lumen and 75% multilumen) experiences annual PICC-related maintenance and complication costs of $1,228,598 (95% CI, $1,053,175-$1,430,958). In such facilities, every 5% increase in single-lumen PICC use would prevent 0.5 PICC-related central line-associated bloodstream infections and 0.5 PICC-related deep vein thrombosis events, while saving $23,500. Moving from 25% to 50% single-lumen PICC utilization would result in total savings of $119,283 (95% CI, $74,030-$184,170) per year. Regardless of baseline prevalence, a single-lumen default PICC policy would be associated with approximately 10% cost savings. Findings remained robust in multiway sensitivity analyses. CONCLUSION Hospital policies that limit the number of PICC lumens may enhance patient safety and reduce healthcare costs. Studies measuring intended and unintended consequences of this approach, followed by rapid adoption, appear necessary. Infect Control Hosp Epidemiol 2016;37:811-817.

Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

“…[27][28][29] Institutional efforts that not only limit the use of multilumen PICCs but also fundamentally define when use of a PICC is appropriate may substantially improve outcomes related to vascular access. 28,30,31 We observed that short-term PICCs were more common in teaching compared to nonteaching hospitals. While the design of the present study precludes understanding the reasons for such a difference, some plausible theories include the presence of physician trainees who may not appreciate the risks of PICC use, diminishing peripheral IV access securement skills, and the lack of alternatives to PICC use.…”

When Is Parenteral Nutrition Appropriate?

“…‐ 32 One meta‐analysis determined that for every 20 single‐lumen catheters placed in lieu of multilumen versions, 1 CLABSI would be avoided, a difference that the authors deemed to be clinically relevant 33 . Similarly, a recent simulation study of peripherally inserted central catheters (PICCs) concluded that hospitals could improve outcomes and decrease costs by instituting policies that stipulate single‐lumen PICCs as the default option 34 . This information takes on greater significance when considering the elevated risk for CVAD complications that accompanies PN administration and intestinal failure 15 , 35 …”

Less Lumens‐Less Risk: A Pilot Intervention to Increase the Use of Single‐Lumen Peripherally Inserted Central Catheters

“…9,18,26 Deliberate use of PICCs with the least numbers of clinically necessary lumens decreases risk of CLABSI, venous thrombosis, and overall cost. 17,19,26 Additionally, greater rates of occlusion with each additional PICC lumen may result in the interruption of intravenous therapy, the administration of costly medications (eg, tissue plasminogen ac-tivator) to salvage the PICC, and premature removal of devices should the occlusion prove irreversible. 8 We observed a trend toward decreased PICC complications following implementation of our criteria, especially for the outcomes of CLABSI and catheter occlusion.…”