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Studies suggest a strong association between the number of lumens in peripherally inserted central catheter (PICC) lines and risk for complications, including central line–associated bloodstream infections, venous thromboembolism, and catheter occlusions. Investigators at a Michigan academic medical center sought to promote use of single-lumen (rather than multi-lumen) PICC lines through a three-part quality improvement intervention: 1) education for hospitalist physicians, pharmacists, and vascular access nurses using a validated appropriateness guide; 2) multidisciplinary development of indications for multi-lumen catheters; and 3) modification of the electronic medical record (EMR) to make single-lumen PICCs the default option (multi-lumen requests to be justified by the clinician and reviewed by a vascular access nurse or pharmacist).
A total of 226 PICC lines were placed during a 10 month-period, with no change in the average number of monthly PICC requests after the intervention, but with a significant reduction in use of multi-lumen PICC lines (35% preintervention vs. 6% postintervention). Placement of PICC lines with appropriate number of lumens significantly increased (74% preintervention vs. 98% postintervention).
Bozaan D et al. Less lumens-less risk: A pilot intervention to increase the use of single-lumen peripherally inserted central catheters. J Hosp Med 2019 Jan 8; 14:42. (https://doi.org/10.12788/jhm.3097)
Comment
Although larger studies are needed to demonstrate that complication rates drop, this quality improvement intervention has the potential to raise dramatically the proportion of PICC lines placed as single-lumen lines. EMR modification and clinician education — components which had the greatest effect — could be generalizable to other institutions.