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Published on: July 13, 2019
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Nudging to select single-lumen over multiple-lumen peripherally inserted central catheters (PICCs) in a large safety
Daniel Alaiev1, Mona Krouss1,2, Sigal Israilov3
1Department of Quality and Safety, New York City Health + Hospitals, New York, New York.
Infection Control and Hospital Epidemiology
|March 24, 2023
Summary
Single-lumen PICCs (peripherally inserted central catheters) are safer than multilumen PICCs but were overused. A quality improvement initiative successfully increased single-lumen PICC use, showing potential for reducing complications in healthcare settings.
Area of Science:
- Healthcare Quality Improvement
- Vascular Access Devices
- Patient Safety
Background:
- Peripherally inserted central catheters (PICCs) are widely used for vascular access.
- Single-lumen PICCs are associated with fewer complications than multilumen PICCs, including lower rates of central-line-associated bloodstream infection (CLABSI) and thrombosis.
- Despite evidence favoring single-lumen PICCs, multilumen PICCs remain overutilized in clinical practice.
Purpose of the Study:
- To evaluate the impact of an electronic health record (EHR) intervention designed to increase the utilization of single-lumen PICCs.
- To assess changes in PICC lumen choice and its effect on complication rates within a large safety net hospital system.
Main Methods:
- A quality improvement initiative was implemented across 11 hospitals within the New York City Health + Hospitals system.
- EHR order sets for interventional radiology or vascular access consultations were modified to default to single-lumen PICCs, allowing lumen choice.
- Data on PICC utilization and CLABSI rates were collected and analyzed pre- and postintervention.
Main Results:
- Average single-lumen PICC utilization significantly increased by 25.5% (from 44.4% to 69.9%, P < .001).
- Central-line-associated bloodstream infection (CLABSI) rates showed a nonsignificant reduction of 26.7% (from 2.44 to 1.79 infections per month, P = .255).
- Significant variation in single-lumen PICC utilization was observed across different provider types, specialties, and hospitals postintervention.
Conclusions:
- The EHR-based intervention successfully increased the utilization of single-lumen PICCs across a large, resource-limited safety net system.
- The findings support the use of default selection nudges in EHRs to promote safer vascular access practices.
- Further research is warranted to understand and address the observed variations in utilization among different healthcare providers and settings.
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