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2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact

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 ev...

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Autores principales: Cheronis, Nicholas, Vietmier, Shawn, McGonial, Shelly, Kriznik, Susan, Bhanot, Nitin, Min, Zaw
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254550/
http://dx.doi.org/10.1093/ofid/ofy210.1758
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author Cheronis, Nicholas
Vietmier, Shawn
McGonial, Shelly
Kriznik, Susan
Bhanot, Nitin
Min, Zaw
author_facet Cheronis, Nicholas
Vietmier, Shawn
McGonial, Shelly
Kriznik, Susan
Bhanot, Nitin
Min, Zaw
author_sort Cheronis, Nicholas
collection PubMed
description 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 healthcare cost. METHODS: We obtained data on all PICCs placed by the vascular access team over a representative 2-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 two patients based on chart review (with cost burden of about $65,000 in these two 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. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62545502018-11-28 2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact Cheronis, Nicholas Vietmier, Shawn McGonial, Shelly Kriznik, Susan Bhanot, Nitin Min, Zaw Open Forum Infect Dis Abstracts 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 healthcare cost. METHODS: We obtained data on all PICCs placed by the vascular access team over a representative 2-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 two patients based on chart review (with cost burden of about $65,000 in these two 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. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6254550/ http://dx.doi.org/10.1093/ofid/ofy210.1758 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Cheronis, Nicholas
Vietmier, Shawn
McGonial, Shelly
Kriznik, Susan
Bhanot, Nitin
Min, Zaw
2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact
title 2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact
title_full 2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact
title_fullStr 2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact
title_full_unstemmed 2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact
title_short 2102. Peripherally Inserted Central Catheter (PICC) Placement: Indications and Financial Impact
title_sort 2102. peripherally inserted central catheter (picc) placement: indications and financial impact
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254550/
http://dx.doi.org/10.1093/ofid/ofy210.1758
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