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HMS PICC Tier II DVT Toolkit

The PICC DVT Tier II toolkit steps focus on the life-cycle of the catheter: appropriate insertion and tip verification, appropriate diagnostic testing, technology-based solutions and line necessity evaluations. For each of these elements, specific guidance and recommendations will be provided.

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  5. Step 1: Review PICC-Related DVT Data

Step 1: Review PICC-Related DVT Data

Key institutional partners to engage in this step: QI Department, HMS PICC Team

Elements:
  • Review PICC-Related DVT cases using the following tools to assess if the correct device and/or number of lumens was appropriate
      • MAGIC guidelines
    • Michigan Risk Score (MRS) – Predicts Risk of DVT in Patients with a PICC
  • Identify which units or types of units (i.e. ICU vs non-ICU) that have the highest rates of PICC-related DVT. Subsequent interventions in this toolkit should be focused on these patient care areas
  • Perform an assessment of potential cost savings from preventing PICC-related DVT
Resources/Tools

Decision Tools:

Tools to Assist with Determining Potential Vesicants:  

PICC Tier 1 Resources and Tools

Articles/References

Chopra V, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. Journal of Thrombosis and Haemostasis 2017

  • Multiple lumens, multiple CVC’s present at time of PICC placement, WBC >12.0, history of VTE and active cancer are associated with increased risk of catheter associated VTE

Chopra V, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Annals of Internal Medicine 2015

  • Criteria for the use of PICCs was developed, adopting the RAND/UCLA Appropriateness Method. After a review of 665 scenarios, 43% of PICCs were flagged as inappropriate. Applying these criteria as a guide can help decrease the likelihood of an inappropriate catheter, improve care, and inform quality improvement efforts

Ratz D, et al. Limiting the number of lumens in peripherally inserted central catheters to improve outcomes and reduce cost:  A simulation study. Infection Control & Hospital Epidemiology 2016

  • Increases in single lumen PICC use resulted in monetary savings and decreases in PICC-associated CLABSI and PICC-associated DVT

Winters JP, et al. Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study. Journal of Thrombosis and Haemostasis 2015

  • Upper extremity deep vein thrombosis (UEDVT) is a relevant complication affecting medical inpatients, accounting for half of hospital-acquired DVTs. Use of central venous catheters (CVCs) was strongly associated with risk of UEDVT with the highest number of events in patients with PICCs