R Scott Evans1, Jamie H Sharp2, Lorraine H Linford2, James F Lloyd3, Scott C Woller4, Scott M Stevens4, C Gregory Elliott4, Jacob S Tripp3, Spencer S Jones5, Lindell K Weaver6. 1. Medical Informatics, Intermountain Healthcare, Salt Lake City, UT; Biomedical Informatics, Salt Lake City, UT. Electronic address: rscott.evans@imail.org. 2. Nutrition Support Service/PICC Team, Salt Lake City, UT. 3. Medical Informatics, Intermountain Healthcare, Salt Lake City, UT. 4. Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Department of Medicine, Intermountain Medical Center, Salt Lake City, UT. 5. RAND Corporation, Salt Lake City, UT. 6. Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT; Department of Medicine, Intermountain Medical Center, Salt Lake City, UT; Hyperbaric Medicine, Intermountain Medical Center and LDS Hospital, Salt Lake City, UT.
Abstract
BACKGROUND: As peripherally inserted central catheter (PICC) use has increased, so has the upper extremity DVT rate. PICC diameter may pose the most modifiable risk for PICC-associated DVT. METHODS: A 3-year, prospective, observational study of all PICC insertions by a specially trained and certified team using a consistent and replicable approach was conducted at a 456-bed, level I trauma and tertiary referral hospital during January 1, 2008, through December 31, 2010. An intensified effort by the PICC team in 2010 was introduced to discuss and reach interdisciplinary consensus on the need for each lumen of the PICC and a change to smaller diameter 5F triple-lumen PICC. RESULTS: Significantly more 4F single-lumen PICCs were used during 2010 (n = 470) compared with 2008 and 2009 (n = 338, 382; P < .0001). DVT rates were similar with the use of 5F triple-lumen PICCs in 2010 as 5F double-lumen PICCs and lower rates than 6F triple-lumen catheters used in 2008 and 2009. The PICC-associated DVT rate was significantly lower (1.9% vs 3.0%, P < .04) in 2010 compared with 2008 and 2009. The cost and length of stay attributable to PICC-associated DVT were $15,973 and 4.6 days. CONCLUSIONS: A significant increase in the use of single-lumen PICCs in addition to the institutional adoption of smaller 5F triple-lumen PICCs was associated with a significant decrease in the rate of PICC-associated DVT.
BACKGROUND: As peripherally inserted central catheter (PICC) use has increased, so has the upper extremity DVT rate. PICC diameter may pose the most modifiable risk for PICC-associated DVT. METHODS: A 3-year, prospective, observational study of all PICC insertions by a specially trained and certified team using a consistent and replicable approach was conducted at a 456-bed, level I trauma and tertiary referral hospital during January 1, 2008, through December 31, 2010. An intensified effort by the PICC team in 2010 was introduced to discuss and reach interdisciplinary consensus on the need for each lumen of the PICC and a change to smaller diameter 5F triple-lumen PICC. RESULTS: Significantly more 4F single-lumen PICCs were used during 2010 (n = 470) compared with 2008 and 2009 (n = 338, 382; P < .0001). DVT rates were similar with the use of 5F triple-lumen PICCs in 2010 as 5F double-lumen PICCs and lower rates than 6F triple-lumen catheters used in 2008 and 2009. The PICC-associated DVT rate was significantly lower (1.9% vs 3.0%, P < .04) in 2010 compared with 2008 and 2009. The cost and length of stay attributable to PICC-associated DVT were $15,973 and 4.6 days. CONCLUSIONS: A significant increase in the use of single-lumen PICCs in addition to the institutional adoption of smaller 5F triple-lumen PICCs was associated with a significant decrease in the rate of PICC-associated DVT.
Authors: Vineet Chopra; Sushant Govindan; Latoya Kuhn; David Ratz; Randy F Sweis; Natalie Melin; Rachel Thompson; Aaron Tolan; James Barron; Sanjay Saint Journal: Ann Intern Med Date: 2014-10-21 Impact factor: 25.391
Authors: Ralph Gnannt; Nicolas Waespe; Michael Temple; Afsaneh Amirabadi; Kuan Liu; Leonardo R Brandão; Bairbre L Connolly Journal: Pediatr Radiol Date: 2018-02-27