Reduction of Peripherally Inserted Central Catheter (PICC) Line Infections Through the Implementation of a Midline Catheter Program

Abstract

Background In 2016, an increase of Central-line associated bloodstream infections (CLABSI) in patients with PICC lines was identified by the CLABSI taskforce. A review was done on all infections and it was determined that PICC lines were often ordered in patients with difficult venous access. A team was formed to evaluate the introduction of a midline catheter program to provide an option for patients that needed vascular access but did not require a central line. Objective: To decrease the incidence of PICC line infections through the addition of a midline catheter program utilizing the using the Michigan Appropriateness Guide for Intravascular Catheters (MAGIC) Guideline algorithm. Methods A prospective quality improvement assessment from August 2017 through July 2019 analyzed the total number of PICC lines placed and any associated infections. Using the MAGIC Guideline algorithm, all requests for PICC line placements were reviewed by a Health Care Provider (HCP) in our Special Procedures Department (SP). If a midline catheter was an appropriate alternative device, the ordering physician was consulted and a mid line catheter was placed. The total number of PICC line catheters placed was monitored for duration of two years. Results : The midline catheter program has resulted in a 20% decrease in PICC line catheter insertions in the 2 years since its implementation. 36 PICC line infections (CLABSIs) were identified in the 24 month period prior to the introduction of the midline catheter program compared to10 PICC line infections in the 24 months after its initiation. There was one midline infection identified during the 2 year period. This was a decrease of 26 infections or 52%. Estimated cost savings of $1,838,096 and 4 deaths prevented deaths using averages from the AHQR website. Conclusions The addition of a midline catheter option is a useful tool to reduce the incidence of infection. In 2016, an increase of Central-line associated bloodstream infections (CLABSI) in patients with PICC lines was identified by the CLABSI taskforce. A review was done on all infections and it was determined that PICC lines were often ordered in patients with difficult venous access. A team was formed to evaluate the introduction of a midline catheter program to provide an option for patients that needed vascular access but did not require a central line. Objective: To decrease the incidence of PICC line infections through the addition of a midline catheter program utilizing the using the Michigan Appropriateness Guide for Intravascular Catheters (MAGIC) Guideline algorithm. A prospective quality improvement assessment from August 2017 through July 2019 analyzed the total number of PICC lines placed and any associated infections. Using the MAGIC Guideline algorithm, all requests for PICC line placements were reviewed by a Health Care Provider (HCP) in our Special Procedures Department (SP). If a midline catheter was an appropriate alternative device, the ordering physician was consulted and a mid line catheter was placed. The total number of PICC line catheters placed was monitored for duration of two years. : The midline catheter program has resulted in a 20% decrease in PICC line catheter insertions in the 2 years since its implementation. 36 PICC line infections (CLABSIs) were identified in the 24 month period prior to the introduction of the midline catheter program compared to10 PICC line infections in the 24 months after its initiation. There was one midline infection identified during the 2 year period. This was a decrease of 26 infections or 52%. Estimated cost savings of $1,838,096 and 4 deaths prevented deaths using averages from the AHQR website. The addition of a midline catheter option is a useful tool to reduce the incidence of infection.