O32 – A Surgeon-Directed Peripherally Inserted Central Catheter Team Utilizing a Novel Screening Protocol to Decrease Infectious Complications and Associated Cost
Author(s):
Background: Since 2000, a selective screening protocol assessing appropriateness of peripherally inserted central catheters (PICC) was introduced by our hospital-wide surgeon-led PICC team.
Hypothesis: We hypothesized that this process is associated with decreased infectious complications and cost.
Methods: Retrospective review of a prospectively maintained database of PICC consults between 2000-2013. All PICC consults are captured by a computer order entry system and then evaluated by a highly specialized team member for indication, duration of intravenous therapy and contraindications. Consults are triaged by urgency and PICCs are inserted using ultrasound and electromagnetic tip imaging. Data regarding PICC indications, reasons for disapproval, location of procedure (bedside versus angiography suite), septic and phlebitic complications were analyzed. Comparisons between PICC and other central venous devices were made. Cost was conservatively estimated to be $491/PICC and supplies, $11,971/blood stream infection (BSI) episode and $7594/DVT episode.
Results: Over the 13-year study time period, 35,651 PICC consults were requested resulting in 24,638 insertions. Over 95% of insertions were successfully accomplished at the bedside within 0.5-day from approval. Comparing PICC with all other central devices, infection rate was 5.9% versus 7.0% (p=0.26) and phlebitis rate was 1.9% versus 2.9% (p=0.43). 30.8% of all the PICC consults were disapproved for reasons including duration of intravenous therapy<3-days, existing central venous access, highly suspected or confirmed BSI, violation of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines, patients not approved by the Nutrition Support Service for TPN and coagulopathy. Attributable cost saved from unnecessary procedures was $5,407,383 and complications avoided (BSI $7,778,361 and DVT $1,589,022) equals $14,774,766.
Conclusions: We demonstrate that implementing a hospital-wide surgeon-led PICC consult service can reduce the total number of PICC placements leading to significant healthcare cost savings.