title: Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study.
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.
authors.affiliation: 1Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System,Ann Arbor,Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Ratz
authors.affiliation: 1Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System,Ann Arbor,Michigan.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hofer
authors.affiliation: 2Division of General Internal Medicine,Department of Medicine,University of Michigan,Ann Arbor,Michigan.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
authors.affiliation: 1Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System,Ann Arbor,Michigan.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.affiliation: 1Center for Clinical Management Research and Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System,Ann Arbor,Michigan.
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
mesh_terms: D055499:Catheter-Related Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation / Q000379:methods; D062905:Central Venous Catheters / Q000009:adverse effects* / Q000191:economics; D017046:Cost Savings / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D020246:Venous Thrombosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control