229. Use of Peripherally Inserted Central Catheters (PICCs) in an Academic Teaching Hospital: Role of Infectious Disease Consultation
Session: Poster Abstract Session: Antimicrobial Stewardship in Clinical Practice
Friday, October 21, 2011
Room: Poster Hall B1
Background: Due to the high convenience of PICCs for long term IV access, their use has considerably increased during the last two decades. However, it has been noted that many are removed earlier than expected raising the question of unnecessary placement prior to confirming the need for long-term IV access.

Objectives: To determine the incidence of unnecessary PICC insertions, and factors associated with their placement.

Methods:  Retrospective, observational review of medical records of all PICC insertions, conducted at a 625-bed academic affiliated community hospital. Unnecessary placement was defined as fewer than 5 days of IV treatment, or patient not discharged from hospital on long-term IV antibiotics. We analyzed the indication given for PICC placement order, and the role of Infectious Disease (ID) consultation. We also analyzed the role of the day of the week, day of hospital admission and the role of teaching vs. non-teaching services on the placement of unnecessary PICCs.

Results:  Over a 4 month-period 228 PICCs were placed. Criteria for catheter use at the time of insertion were met in 79% cases (95%CI= 73.3-83.9). For 71 cases where the indications for placement were the need of chemotherapy, total parenteral nutrition, or long-term non-antibiotic IV therapy no unnecessary placement was found.  For the 109 placements for long-term antibiotic use 12 (11%) were classified as unnecessary. For 48 PICC placements no criterion for placement was given at the time of insertion, and 34 cases (71%) were unnecessary. Of the total 46 cases where PICCs were unnecessary, ID was consulted in only 18 cases, but in 9 cases the PICC was already placed and in the other cases ID recommendations were not followed. We saw no increased placement of PICCs based on day of the week (p-value 0.14), teaching vs. non-teaching services (p-value 0.21), or hospital day of insertion (p-value 0.29).

Conclusion: The majority of PICCs placed were needed. Unnecessary placement cases were most often those where no clear indication was given. Requiring documentation of the indication with all orders for PICC placement could be a simple step to reduce unnecessary placement. For ID consultation to further reduce unnecessary placement would require consultation be requested prior to order PICCs.


Subject Category: J. Clinical practice issues

Graciela Faiad, MD1, Aarthi Narasimhan, MD2, Anna Agarkova, MD3, Simon Paul, MD2,4, Naiel Nassar, MD5 and Paul Mills, PhD3, (1)Internal Medicine, Infectious Disease Division, UCSF Fresno, Fresno , CA, (2)Infectious Diseases, UCSF-Fresno, Fresno, CA, (3)Internal Medicine, UCSF Fresno, Fresno, CA, (4)UCSF-Fresno, Fresno, CA, (5)Infectious Diseases, UCSF- Fresno, Fresno, CA

Disclosures:

G. Faiad, None

A. Narasimhan, None

A. Agarkova, None

S. Paul, None

N. Nassar, None

P. Mills, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.