Decrease use of multi-lumen PICCs; Increase use of single lumen PICCs

Action Items:

• 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) 
• Sample hospital guide for the use of single vs. multi-lumen PICCs 
• Estimate cost and complication savings from greater use of single lumen PICCs
• The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC)
  •  Video- The Michigan MAGIC, PICC Appropriateness & Mindful Medicine
  •  App- ImprovePICC MAGIC App
• Example Inpatient PICC Order set Criteria ​

References: ​

• Ratz D, et al. Limiting the Number of PICC Lumens to Improve Outcomes and Reduce Cost: A Simulation Study. Infection Control & Hospital Epidemiology 2016
  • Every 5% increase in single-lumen PICC use would prevent 0.5 PICC-related central line-associated bloodstream infections and 0.5 PICC-related deep vein thrombosis events, while saving $23,500.
• 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 
• 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.
• 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.

Return to Step 3

Proceed to Step 5