HMS PICC Tier II DVT Toolkit

To address PICC-related DVT, institutions should review cases using tools like the MAGIC guidelines and the Michigan Risk Score (MRS) to assess whether the device type and number of lumens were appropriate. Focus should be placed on units with the highest DVT rates, such as ICUs, to guide targeted interventions. Additionally, evaluating potential cost savings from preventing PICC-related DVT can support quality improvement efforts.

To reduce PICC-related DVT, use validated tools like MAGIC and the Michigan Risk Score to guide device selection, avoiding PICCs in high-risk patients (e.g., ICU stays <14 days, cancer, recent VTE). Prioritize single-lumen catheters, assess catheter-to-vein ratio (CVR < 45%) using ultrasound, and confirm tip placement with ECG or fluoroscopy. Integrate decision tools into policies and order sets, and audit documentation to ensure safe and appropriate PICC use.

To prevent PICC-related DVT, ensure proper care and maintenance through regular dressing audits, securement of the catheter to prevent movement, and up-to-date nursing competencies. Avoid systemic anticoagulants for prophylaxis, as they don’t reduce DVT risk, and limit blood transfusions via PICC. Patient education on PICC care and precautions should be provided at insertion and discharge to support safe use.

To support high-risk patients, institutions may consider using antithrombotic PICCs like Endexo (e.g., BioFlo). However, reversed taper catheters are not recommended due to insufficient evidence of their effectiveness in reducing PICC-related DVT.

To ensure PICC necessity and reduce DVT risk, institutions should conduct daily audits with multidisciplinary teams. Lines unused for over 24–48 hours should be reviewed for removal, and devices should be de-escalated to peripheral access when possible. PICCs placed in ICU settings should be reassessed before transfer, with removal plans documented if no longer needed.

To ensure appropriate testing for PICC-related DVT, only evaluate patients who show symptoms—routine screening in asymptomatic individuals is not recommended. Use compression ultrasonography for arm vein assessment, and consider CT angiography or CT venography for central or catheter-related thrombosis, with CT venography being the gold standard.