Appropriate device choice and insertion - only use a PICC if necessary AND only use in populations at low risk of DVT
Element |
Key Institutional Partners |
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Hospital Leadership, HMS PICC Team, QI Department |
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Hospital Leadership, HMS PICC Team, QI Department |
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Hospital Leadership, Providers, IR, Vascular Access Team |
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Hospital Leadership, Providers, IR, Vascular Access Team |
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Hospital Leadership, Providers, IR, Vascular Access Team |
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Providers, IR, Vascular Access Team |
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Providers, IR, Vascular Access Team |
Resources/Tools
Assessment/Decision Tools
The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC)
Infusion Therapy Standards of Practice 2016 (Paid) Vascular Access Dashboard (PICC Excellence) Tools to Assist with Determining Potential Vesicants: INS List of Noncytotoxic vesicant list Cincinnati Children’s List of Venous Infusion Extravasation Risk Intermountain Medical Center Irritants and Vesicants Guide Michigan Medicine List of Medications with Irritant or Vesicant Properties Example Inpatient PICC Order Set Criteria |
Articles/References
The SIP Protocol- A GAVeCeLT bundle for the safe implantation of PICCs
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
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Validation Survey
DVT Step 2 Validation - Appropriate Device Choice and Insertion.
DVT Step 2 Validation - Appropriate Device Choice and Insertion.
- 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.
Always place a PICC with the smallest size catheter/least number of lumens possible
Element |
Key Institutional Partners |
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Hospital Leadership, Vascular Team, QI Department |
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Hospital Leadership, Vascular Team, QI Department |
Resources/Tools
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Articles/References
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Zehnder J, et al. Catheter-related upper extremity venous thrombosis. Up To Date. 2018
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Validation Survey
DVT Step 2 Validation - Smallest Gauge/Least Lumens.
DVT Step 2 Validation - Smallest Gauge/Least Lumens.
- 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.
Avoid PICCs in patients with a higher risk of DVT
Element |
Key Institutional Partners |
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Vascular Access Team |
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Providers, IR, Vascular Access Team |
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Providers, IR, Vascular Access Team |
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Providers, IR, Vascular Access Team |
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Providers, IR, Vascular Access Team |
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Providers, IR, Vascular Access Team |
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Providers, IR, Vascular Access Team |
Resources/Tools
Decision Tools: Michigan Risk Score (MRS) to Predict risk of DVT in Patients with a PICC Patient education tool on DVT risk |
Articles/References
Chopra V, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. Journal of Thrombosis and Haemostasis 2017
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Validation Survey
DVT Step 2 Validation - Avoid PICCs in Patients with Higher Risk of DVT.
DVT Step 2 Validation - Avoid PICCs in Patients with Higher Risk of DVT.
- 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.
Use ultrasound and measure catheter to vein ratio
Element |
Key Institutional Partners |
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Providers, IR, Vascular Team, Hospital Leadership |
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Providers, IR, Vascular Team, Hospital Leadership |
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Providers, IR, Vascular Team, Hospital Leadership |
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Providers, IR, Vascular Team, Hospital Leadership |
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PICC Team, Data Abstractor, QI Department |
Articles/References
Hughes ME. PICC related thrombosis: pathophysiology, incidence, morbidity and the effect of ultrasound-guided placement technique on occurrence in cancer patients. Journal of the Association for Vascular Access 2011
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Validation Survey
DVT Step 2 Validation - Catheter to Vein Ratio.
DVT Step 2 Validation - Catheter to Vein Ratio.
- 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.
Ensure that the Catheter Tip is Located in the Lower 1/3rd of the Superior Vena Cava (SVC), Cavoatrial Junction (CAJ) or in the Right Atrium at the Time of PICC Placement
Element |
Key Institutional Partners |
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Providers, IR, Vascular Team, Hospital Leadership |
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Providers, IR, Vascular Team, Hospital Leadership |
Articles/References
Zehnder J, et al. Catheter-related upper extremity venous thrombosis. Up To Date 2018
Zehnder J, et al. Catheter-related upper extremity venous thrombosis. Up To Date 2018
- Intravenous catheters cause endothelial trauma and inflammation that often progresses to venous thrombosis. Three-quarters of thrombotic events occurring in veins of the upper extremity are due to the presence of intravenous catheters. This article provides a detailed summary of the available evidence for detecting, identifying, and treating upper extremity deep vein thrombosis
- The “tailored fit” formula to individual patient height is a reliable tool to predict CVC length. Appropriate catheter length can greatly reduce the guesswork and possibility of complications related to tip malposition
- Details the proper tip location (Zone A, B & C)
- Case report and literature review related to PICC displacement or migration after contrast injection for radiologic study recommending review of catheter tip position following CT
Validation Survey
DVT Step 2 Validation - Final Insertion Validation.
DVT Step 2 Validation - Final Insertion Validation.
- 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.