Review and Address Device Factors
Element
Key Institutional Partners
  • Use the catheter with the least number of lumens 
    • Use MAGIC or another validated decision tool to determine appropriate device lumens
Hospital Leadership, Providers, IR, Vascular Access Team, IT
  • Evaluate who is determining appropriateness/number of lumens 
    • Consider if another clinician type should be involved (i.e. Vascular Access Teams)
    • Ensure those identified as most appropriate to determine appropriateness/number of lumens are educated on appropriate device choice/insertion
Hospital Leadership, HMS PICC Team, QI Department
  • Default PICC order sets to single lumen use unless reasons for multi-lumen catheters exist
Hospital Leadership, Providers, IR, Vascular Access Team, IT
  • Create guidelines which specify conditions/indications in which multi-lumen PICCs are appropriate to guide use at your hospital
    • Example:  Use the Michigan Less Lumens – Less Risk criteria when selecting a multi-lumen catheter
Providers, IR, Vascular Access Team
Resources/Tools
Assessment/Decision Tools Tools to Assist with Determining Potential Vesicants: Example Inpatient PICC Order Set Criteria 
PICC Tier 1 Resources and Tools
Articles/References
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
Xiong Z, et al. Interventions to reduce unnecessary central venous catheter use to prevent central line-associated blood stream infections in adults:  A systematic review. Infection Control & Hospital Epidemiology 2018
  • Interventions aimed at improving CVC appropriateness, assessment, and prompt device removal significantly reduce CLABSI rates. Analysis of secondary outcomes showed a decrease in catheter occlusion
Smith S, et al. Patterns and predicators of peripherally inserted central catheter occlusion:  The 3P-O Study. Journal of Vascular and Interventional Radiology 2017
  • Patient, Provider and Device Factors Associated with Catheter Occlusion
    • Device Factors (strongest predictors of occlusion)- higher gauge, double lumen, triple lumen, catheter tip malposition at any point during dwell
Lam PW, et al. Impact of defaulting to single-lumen peripherally inserted central catheters on patient outcomes:  An interrupted time series study. Clinical Infectious Diseases 2018
  • Defaulting non-ICU PICC orders to single-lumen devices resulted in a sustained decrease in PICC-associated complications, particularly occlusion
Swaminathan L, et al. Improving PICC use and outcomes in hospitalized patients:  An interrupted time series study using MAGIC criteria. BMJ Quality & Safety 2018
  • A multi-modal intervention based on MAGIC resulted in a modest decrease in inappropriate PICC use
Bozaan D, et al. Less lumens-less risk:  A pilot intervention to increase the use of single-lumen peripherally inserted central catheters. Journal of Hospital Medicine 2019
  • An intervention involving setting PICC default orders to single-lumen devices, establishing criteria of when multi-lumen PICCs are appropriate, and provider, nursing, and pharmacy education resulted in significant decrease in inappropriate PICC use, as well as an overall increase in single lumen PICC use
Validation Survey
Occlusion Step 2 Validation - Device Factors
  • 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. 
Review use of valves/connectors
Element
Key Institutional Partners
  • Often, occlusion has to do with connectors, not the catheter itself
Hospital Leadership, Providers, IR, Vascular Access Team
  • Neutral connectors have the least displacement and may be the best choice
Hospital Leadership, Providers, IR, Vascular Access Team
  • Certain connectors are anti-reflux and can lower risk of occlusion
Hospital Leadership, Providers, IR, Vascular Access Team
Articles/References
​Hitchcock J, et al. Preventing intraluminal occlusion in peripherally inserted central catheters. British Journal of Nursing 2016
  • Results suggested the introduction of the bi-directional needle-less connector had a positive impact on the persistent withdrawal occlusion and occlusion rates in PICCs
Validation Survey
Occlusion Step 2 Validation - Review Use of Valves/Connectors
  • 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.