04:03 PM Abstract No. 360 Introduction of nursing-placed MLCs and USGIVs promotes safer catheter selection

Abstract

Deep vein thrombosis (DVT) and central line-associated bloodstream infection (CLABSI) are serious complications of peripherally inserted central catheters (PICCs). Midline catheters (MLCs) do not carry the risk of CLABSI, and while DVT remains a possibility, it is less extensive with MLCs. Because of these risks, MLCs and ultrasound-guided intravenous catheters (USGIVs) were added to the capabilities of the host institution’s nursing-based venous access team (VAT) which operates under direction of and with support of IR. This study evaluates this effort to reduce PICCs and MLCs through appropriate patient-centered device choice. A retrospective analysis using the VAT’s record of all catheters placed September 2001–March 2018 was conducted. These data were supplemented with data from the IR QA database (Hi-IQ), thereby accounting for nearly all* PICCs, MLCs, and USGIVs placed in inpatients in a large tertiary care academic hospital. Analysis of hospital records of PICC-associated DVT and CLABSI was also performed. 30,659 PICCs, 12,135 MLCs, and 14,300 USGIVs were placed by the VAT (September 2001–March 2018). From the peak of VAT PICCs in 2006 to the peak of MLCs in 2010, PICCs decreased 23% (p < 0.01), while MLCs increased 93% (p < 0.001). Following full implementation of USGIV in January 2016, MLCs decreased 34% from 2015 to 2016 (p < 0.01) with no concurrent decrease in PICCs (p = 0.72). The total hospital PICCs decreased from a peak of 3596 (867 IR, 2729 VAT) in the 2006 fiscal year (FY) to 2295 in FY 2017 (546 IR, 1749 VAT). CLABSI counts decreased from a mean of 4.8 per month in FY 2008 to 2.3 in 2009 (p < 0.05), though no significant decrease was found from FY 2008 to 2013 (n = 4.8 vs. n = 3.5, p = 0.26). No interpretable trends in DVT counts were discovered. Appropriate use of MLCs and USGIVs by an IR-supported VAT significantly decreased PICCs and MLCs, respectively. *Data incomplete for 2005, 2006, 2007, and 2018.Tabled 1VAT-Placed Catheters by Monthly MeanYearsPICCsMLCsUSGIVsTotal2005-2007*194 (79%)52 (21%)0 (0%)2462008-2010204 (62%)126 (38%)0 (0%)3302011-2013191 (56%)98 (29%)53 (15%)3422014-2016157 (38%)60 (15%)194 (47%)4102017-2018134 (25%)45 (8%)353 (66%)532 Open table in a new tab