Each day with a PICC increases the risk of thrombosis; daily multidisciplinary rounds for device use/necessity is recommended
Element
Key Institutional Partners
  • Daily audits of lines to determine clinical necessity of the device
    • Rounds should be multi-disciplinary, including physician and nursing leadership at the unit-level whenever possible
Providers, IR, Vascular Access Team, Hospital Leadership/Nursing Leadership, QI Department
  • De-escalate devices to peripheral access whenever possible
    • If a line has not been used for >24 hours, consider targeting it for removal
    • Daily labs are not an indication for a central venous catheter or a PICC unless the frequency of lab draws is >3 times per day
    • If a line has not been used >48 hours, it should be considered idle and removed
Providers, IR, Vascular Access Team, Hospital Leadership/Nursing Leadership, QI Department
  • PICCs that are placed in the ICU setting should be reviewed prior to patient transitioning out of the ICU
    • If not necessary, remove and secure peripheral access
    • If necessary, determine and document date of removal and ensure process for removal is in place
Providers, IR, Vascular Access Team, Hospital Leadership/Nursing Leadership, QI Department
​Resources/Tools
I-DECIDED PICC Assessment and Decision Tool for Nurses
Line Necessity and De-Escalation Rounding and Auditing Tool
Care and Maintenance Handout for Nurses
Articles/References
​McDonald EG, & Lee, TC. Venous catheter use in medical inpatients through regular physician audits using an online tool. JAMA Internal Medicine 2015
  • Use of an online audit tool by Physicians focused on re-evaluating CVC appropriateness resulted in a 46.6% reduction in use of CVCs 
Aufricht G, et al. Analysis of central venous catheter utilization at a quaternary care hospital. Baylor University Medical Center Proceedings 2019
  • Audit and feedback regarding appropriateness of central lines resulted in a decrease of 65% of central venous catheters that were not clinically indicated
Lederle FA, et al. The idle intravenous catheter. Annals of Internal Medicine 1992 
  • Twenty percent of all patient-days of IV catheter use were idle. Efforts should focus on reducing unnecessary use
Parenti CM, et al. Reduction of unnecessary intravenous catheter use. Internal medicine house staff participate in a successful quality improvement project. Archives of Internal Medicine 1994 
  • Idle IV catheter episodes decreased significantly after a house staff-led intervention. House staff proved critical to successful quality improvement and should be further included to improve patient care and enhance education of quality improvement processes
Validation Survey
​DVT Step 5 Validation - Line Necessity/Removal.
  • 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.