Line Necessity/Removal 
Element
Key Institutional Partners
  • Daily audits of lines to determine clinical necessity of the device
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership, QI Department
  • Rounds should be multi-disciplinary, including physician and nursing leadership at the unit-level whenever possible
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership, QI Department
  • If a line has not been used for >24 hours - query physician regarding PICC necessity
    • De-escalate devices to peripheral whenever possible
    • Daily labs are not an indication for a central venous catheter or a PICC unless the frequency of lab draws is >3 times per da
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership, QI Department
  • If a line has not been used >48 hours, it should be considered idle – query physician regarding PICC removal
​Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership, QI Department
  • PICCs or CVCs 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 or conditions of removal and ensure process for removal is in place
Providers, IR, Vascular Team, Hospital Leadership/Nursing Leadership, QI Department
​Resources/Tools
Articles/References
​ ​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
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
Occlusion Step 6 Validation - Line Necessity and 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.