Background: Although PICCs are important for venous access, they pose risk of infection, venous thrombosis, and are costlier relative to other forms of vascular access. We conducted a preliminary quality improvement study to assess the indications for PICC placement at our institution and also to evaluate the associated health care cost.
Methods: We obtained data on all PICCs placed by the vascular access team over a representative two-month period (November and December 2017) at Allegheny General Hospital. Indications entered during order entry for PICC placement were collected. Additionally, charts of all central line associated blood stream infections (CLABSI) in 2017 were reviewed to determine the number of events where PICC may have been implicated. We calculated the cost incurred for PICC placement and that for treating infection in PICC associated CLABSI. The cost of each PICC insertion is about $4,700 and that of each CLABSI approximates $25,000.
Results: A total of 451 PICCs were inserted over the 2 month period. Documented indications for PICC insertion included: poor venous access (128, 28.3%), receiving high-risk drugs (91, 20%), requires multiple simultaneous IV infusions (84, 18.6%), needed upon discharge for long term use (63, 13.9%), and receiving vasopressors, total parental nutrition or chemotherapy (61, 13.6%). There was no indication described for 23 PICC orders (5.2%). Twenty five CLABSI were encountered in 2017; 10 of them were PICC associated. Of those, PICC was not absolutely indicated in 2 patients based on chart review (with cost burden of about $65,000 in these 2 instances).
Conclusion: Poor venous access and multiple IV infusions are not absolute indications for PICC insertion in most circumstances. In our study, this amounted to nearly half (212/451) of the indications for PICC placement. Our hospital could have potentially saved a million dollars in the 2-month study period if PICCs were not placed for these indications. Given the costs and risks associated with PICC use, alternative venous access devices should be strongly considered. By rigorously reevaluating indications for PICC use we may improve both patient outcomes and reduce healthcare costs.
S. McGonial, None
S. Kriznik, None
N. Bhanot, None
Z. Min, None