HMS launched an initiative focusing on peripherally inserted central catheters, or “PICCs” with 10 pilot hospitals in late 2013 and across all member hospitals in the Spring of 2015. PICCs are long, slender venous catheters (or tubes) that are inserted into a peripheral vein, usually in the arm in adults. The end of the catheter is positioned near the heart so as to obtain central venous access for delivery of drugs or access for blood draws. PICCs are used for many different reasons in hospitalized patients including for long-term antibiotic therapies, chemotherapy, nutrition, or frequent blood draws. Members of the collaborative voted upon an initiative focused on PICC use after considering several other potential QI projects all of which were geared towards reducing adverse events in hospitalized medical patients. Ultimately, the collaborative decided to focus on PICCs because the use of these devices is growing in hospitalized medical patients and evidence supporting best practices (including indications for use and management of complications) remains sparse.
An article published in the Journal of Hospital Medicine highlights hospitalist PICC knowledge, experiences and opinions in 10 Michigan hospitals including some HMS hospitals. The survey found significant variation in clinical practice associated with these devices. For instance, 47% of the respondents (144 hospitalists) indicated that 10-25% of PICCs inserted in their hospitals might be avoidable or represent inappropriate use. This finding is relevant because, while PICCs offer several benefits to patients and providers, they are invasive devices that are known to be associated with two of the most costly and morbid complications in hospitalized patients: central line-associated blood stream infection (CLABSI) and venous thromboembolism (VTE). In addition, PICC placement also incurs costs associated with insertion of the device and subsequent maintenance. Several other potential practice-related concerns were also identified in the survey including lack of awareness of PICC presence, variability in utilization of PICCs and management of complications, all of which may increase patient harm and drive up health care costs.
With this initiative, the collaborative aims to formally assess appropriate uses of PICCs, identify factors associated with complications, and improve the safety of hospitalized medical patients by eliminating unnecessary PICC use and preventing complications.