IMPROVE PICC
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Increase use of single lumen PICCs; decrease use of multi-lumen PICCs

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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
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​​Resources & Tools: 
  • ​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​
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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.​
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  • HOME
  • RESEARCH
    • Michigan Risk Score
    • CLABSI GPS
    • CLABSI Cost Calculator
    • MAGIC Webinar
    • Research Publications
  • MAGIC
    • MAGIC App
    • Learn More
    • Read the Study
    • Impact >
      • Press Coverage
  • RESOURCES
    • Multimedia
    • Slides & Handouts
    • Key Guidelines
  • Implementation
    • Tier I Toolkit >
      • Tier I Step 1
      • Tier I Step 2
      • Tier I Step 3
      • Tier I Step 4
      • Tier I Step 5
    • Tier II Toolkit >
      • CLABSI Toolkit
      • Occlusion Toolkit
      • DVT Toolkit
  • PARTNERS
    • Become A Partner
  • ABOUT
    • Mission
    • Team
    • Contact
  • Blog