Skip to main content
Home HMS signature

HMS Critical Care Vascular Access Toolkit

In critical care, evidence-based vascular access guidelines, decision support tools, and structured communication protocols reduce complications, enhance patient safety, and support consistent, high-quality, and cost-effective care.

  1. Home
  2. Quality Initiatives
  3. PICC Initiative
  4. HMS Critical Care Vascular Access Toolkit
  5. Decrease Use of Triple Lumen PICCs in the Critically Ill Patient Population

Decrease Use of Triple Lumen PICCs in the Critically Ill Patient Population

Background, Rationale and Suggested Implementation Strategies
  • Triple lumen PICCs have a more lumens, increasing the potential for catheter-related bloodstream infections. Using single or double lumen PICCs or more temporary triple lumen lines (triple lumen central venous catheters [CVCs]) when clinically appropriate can reduce this risk.
  • Create or share educational materials regarding the importance of lumens and risk of complications associated with triple lumen PICCs.
  • Educating staff about the appropriate indications for each type of catheter supports evidence-based practice and enhances the quality of care delivered.
  • Create and/or use guidelines based on evidence that outline the scenarios in which single, double, or triple lumen PICCs are appropriate, ensuring alignment with national safety standards.
  • Establish a feedback loop where healthcare workers can share experiences, challenges, and successes in reducing triple lumen PICC use to continuously improve and adapt practices.
  • Engage with key stakeholders, including nurses, physicians, and administrators, to secure buy-in and support for reducing triple lumen PICC use, highlighting the benefits for patient safety and cost savings.
Resources and Tools
References
  • Govindan, S. et al. Peripherally Inserted Central Catheter in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals. SCCM 2018.
    • The study examined over 27,000 patients to evaluate the use and complications of PICCs in ICUs versus general wards, revealing that PICCs in the ICU are more frequently multilumen and associated with higher complication rates compared to those on the general ward. Additionally, significant variation in PICC use and outcomes across hospitals and frequent use in circumstances deemed inappropriate according to published criteria suggest a need for further investigation into vascular access decision-making in the ICU setting.
  • Trerotola, S. et al. Triple-Lumen Peripherally Inserted Central Catheter in Patients in the Critical Care Unit: Prospective EvaluationRadiological Society of North America 2010.
    • The study evaluating the use of triple-lumen PICCs in ICU patients was halted prematurely after an interim analysis revealed a high rate of venous thrombosis, affecting 58% of patients, with 20% being symptomatic. Despite the high thrombosis rate, there was no incidence of catheter-related bloodstream infections and a low rate of colonization, indicating that while the triple-lumen PICC design has issues with thrombosis, it presents a low infection risk in a high-risk ICU setting.
  • Govindan, S. et al. To PICC or not to PICC? A Cross-Sectional Survey of Vascular Access Practices in the ICUJournal of Critical Care 2021.
    • The study surveyed ICU clinicians across 13 Michigan hospitals to understand their practices and perceptions regarding the shift from CVCs to PICCs, finding significant variability in the use of ultrasound and specification of catheter lumens. The results suggest that local protocols could enhance adherence to guidelines and highlight the need for further research on vascular access and patient safety in the ICU