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Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

Published online by Cambridge University Press:  01 April 2016

David Ratz ,
Timothy Hofer ,
Scott A. Flanders ,
Sanjay Saint  and
Vineet Chopra
David Ratz
Affiliation:
Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
Timothy Hofer
Affiliation:
Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
Scott A. Flanders
Affiliation:
Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
Vineet Chopra*
Affiliation:
Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
*
Address correspondence to Vineet Chopra, MD, MSc, 2800 Plymouth Rd, Bldg 16 #432W, Ann Arbor, MI 48105 (vineetc@med.umich.edu).
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Abstract

BACKGROUND

The number of peripherally inserted central catheter (PICC) lumens is associated with thrombotic and infectious complications. Because multilumen PICCs are not necessary in all patients, policies that limit their use may improve safety and cost.

OBJECTIVE

To design a simulation-based analysis to estimate outcomes and cost associated with a policy that encourages single-lumen PICC use.

METHODS

Model inputs, including risk of complications and costs associated with single- and multilumen PICCs, were obtained from available literature and a multihospital collaborative quality improvement project. Cost savings and reduction in central line–associated bloodstream infection and deep vein thrombosis events from institution of a single-lumen PICC default policy were reported.

RESULTS

According to our model, a hospital that places 1,000 PICCs per year (25% of which are single-lumen and 75% multilumen) experiences annual PICC-related maintenance and complication costs of $1,228,598 (95% CI, $1,053,175–$1,430,958). In such facilities, every 5% increase in single-lumen PICC use would prevent 0.5 PICC-related central line-associated bloodstream infections and 0.5 PICC-related deep vein thrombosis events, while saving $23,500. Moving from 25% to 50% single-lumen PICC utilization would result in total savings of $119,283 (95% CI, $74,030–$184,170) per year. Regardless of baseline prevalence, a single-lumen default PICC policy would be associated with approximately 10% cost savings. Findings remained robust in multiway sensitivity analyses.

CONCLUSION

Hospital policies that limit the number of PICC lumens may enhance patient safety and reduce healthcare costs. Studies measuring intended and unintended consequences of this approach, followed by rapid adoption, appear necessary.

Infect Control Hosp Epidemiol 2016;37:811–817

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 811 - 817
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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