Review identified PICC-related DVT cases
Element
Key Institutional Partners
  • Review PICC Related DVT cases using the following tools to assess if the correct device and/or number of lumens was appropriate
    • MAGIC guidelines
    • Michigan Risk Score (MRS) – Predicts Risk of DVT in Patients with a PICC
QI Team, Vascular Access Team
  • Identify which units or types of units (i.e. ICU vs non-ICU) that have the highest rates of PICC-related DVT. Subsequent interventions in this toolkit should be focused on these patient care areas
QI Team, Vascular Access Team
Resources/Tools
Audit tool to review PICC-DVT cases 
​Decision Tools: 
Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) Badge Card for Peripherally Compatible Infusates
Michigan Risk Score (MRS) to Predict risk of DVT in Patients with a PIC Infusion Therapy Standards of Practice 2016 (Paid)
Intermountain Medical Center Algorithm for IV Access 
Vascular Access Dashboard (PICC Excellence)
WOCOVA Difficult Intravenous Access Pathway (DIVA)- Slides
Tools to Assist with Determining Potential Vesicants:  
Articles/References
Winters JP, et al. Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study. Journal of Thrombosis and Haemostasis 2015
  • Upper extremity deep vein thrombosis (UEDVT) is a relevant complication affecting medical inpatients, accounting for half of hospital-acquired DVTs. Use of central venous catheters (CVCs) was strongly associated with risk of UEDVT with the highest number of events in patients with PICCs
Chopra V, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. Journal of Thrombosis and Haemostasis 2017 
  • Multiple lumens, multiple CVC’s present at time of PICC placement, WBC >12.0, history of VTE and active cancer are associated with increased risk of catheter associated VTE
Chopra V, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Annals of Internal Medicine 2015
  • Criteria for the use of PICCs was developed, adopting the RAND/UCLA Appropriateness Method. After a review of 665 scenarios, 43% of PICCs were flagged as inappropriate. Applying these criteria as a guide can help decrease the likelihood of an inappropriate catheter, improve care, and inform quality improvement efforts
Validation Survey
DVT Step 1 Validation - Review DVT Data.
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress. 
​Perform an assessment of potential cost savings from preventing PICC-related DVT 
Element
Key Institutional Partners
  • Perform an assessment of potential cost savings from preventing PICC-related DVT 
QI Team, Hospital Leadership
Resources/Tools
Decision Tools:
PICC-Safety and Cost Calculator
Articles/References
Ratz D, et al. Limiting the number of lumens in peripherally inserted central catheters to improve outcomes and reduce cost:  A simulation study. Infection Control & Hospital Epidemiology 2016
  • Increases in single lumen PICC use resulted in monetary savings and decreases in PICC-associated CLABSI and PICC-associated DVT
Validation Survey
DVT Step 1 Validation - Perform an Assessment of Potential Cost Savings.
  • This document includes all of the validation questions associated with this content area to help with collaboration on responses for your hospital. Responses to the validation questions should be entered in to the linked document and recorded to monitor progress.