Decrease use of multi-lumen PICCs; Increase use of single lumen PICCs
Create or share educational materials regarding the importance of lumens and risk of complications associated with central venous catheters, including PICCs.
Consider implementing a strategy that defaults to use of single lumen PICCs unless an approved indication/rationale for placing a multi-lumen PICC exists
If/when a double lumen or greater PICC is requested, ask clinical providers for justification regarding why a multi-lumen PICC is necessary
Develop a list of criteria for when a multi-lumen PICC might be necessary. One such criteria is the Michigan “Less Lumens / Less Risk” criteria (link)
Inserters placing PICCs should review justification for multi-lumen PICCs and make the final decision regarding the appropriate number of lumens in conjunction with ordering providers
Include pharmacists for discussions regarding medication incompatibility to understand whether strategies such as spacing out medication administration or diluting medications to ensure safe peripheral infusion can be considered
If a PICC is required for continued treatment in the outpatient setting, consider down-grading to single lumen device to reduce risk of complications
Resources & Tools:
HMS site reports (hard copy distributed at collaborative wide meetings and live reports available daily via the HMS data entry system)
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
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.