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

Abstract

To reduce risk of complications, existing guidelines recommend use of peripherally inserted central catheters (PICCs) with the minimal number of lumens. This recommendation, however, is difficult to implement in practice. We conducted a pilot study to increase the use of single‐lumen PICCs in hospitalized patients. The intervention included (1) education for physicians, pharmacists, and nurses; (2) changes to the electronic PICC order‐set that set single lumen PICCs as default; and (3) criteria defining when use of multilumen PICCs is appropriate. The intervention was supported by realtime monitoring and feedback. Among 226 consecutive PICCs, 64.7% of preintervention devices were single lumen versus 93.6% postintervention (P < .001). The proportion of PICCs with an inappropriate number of lumens decreased from 25.6% preintervention to 2.2% postintervention (P < .001). No cases suggesting inadequate venous access or orders for the placement of a second PICC were observed. Implementing a single‐lumen PICC default and providing education and indications for multilumen devices improved PICC appropriateness.

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

“…66,76 Evidence evaluating multilumen PICC outcomes was mixed. One study found DVT risk increased with $2 lumens, 67 another study reported a nonsignificant reduction in CLABSI risk with single-lumen use, 39 while a number of other studies reported that PICC lumen number was not significantly associated with the risk of thrombosis 81,122 or infection. 81 Overall, most studies found occlusion was the most common complication associated with catheter lumen number, and $2 lumen PICCs were associated with the highest risk of occlusion.…”

“…81 Overall, most studies found occlusion was the most common complication associated with catheter lumen number, and $2 lumen PICCs were associated with the highest risk of occlusion. 28,39,81 Similarly, studies reported mixed outcomes on the basis of CVAD lumen number. Two studies reported no association between single-and double-lumen catheters and rates of infection 65 and major CVAD-related complications, 26 whereas others reported higher rates of CLABSI, 46,106 exit-site or tunnel infection, 46 malfunction or occlusion, 46 and complications requiring repositioning 26 for doublelumen CVADs.…”

The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC

“…Since publication, MAGIC has been implemented in many hospitals worldwide but particularly in the United States, with evidence suggesting significant reductions in inappropriate VAD use, patient harm, and costs. [9][10][11] Similar evidence-based VAD appropriateness criteria have not been developed for pediatrics. Therefore, we sought to develop the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC), a pediatric-focused version of its adult counterpart, using the RAND Corporation and University of California, Los Angeles (RAND/ UCLA) Appropriateness Method 12 to address this knowledge gap.…”

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

“…Additionally, we did not have data on direct cost or thrombosis rates, though we expect improvement based on the results of previous studies. 8,9 In conclusion, our intervention led to a significant and sustained decrease in the utilization of multilumen PICCs and a relative increase in utilization of single-lumen PICCs, with an associated downward trend in PICC-related CLABSI events. Future studies should be done across multiple sites to validate these findings with the statistical power needed to show expected improvements in clinical outcomes, particularly in infection and thrombosis and cost-effectiveness.…”