HMS PICC Tier I Toolkit

To improve PICC use and outcomes, convene a vascular access committee that meets monthly to quarterly and includes key stakeholders such as organizational leaders, vascular access teams, physicians from critical care and other specialties, and interventional radiology. This committee should review HMS and local data, identify improvement opportunities, implement targeted strategies, and designate an internal facilitator and physician champion to drive PICC-related quality initiatives and monitor their impact.

Implementing a PICC decision tool involves identifying or adapting an evidence-based guide to assess appropriateness prior to insertion, ensuring collaboration with experienced operators, and designating a physician champion to support its use and resolve uncertainties. Successful deployment requires engaging frontline staff and the vascular access committee for feedback, providing targeted education, and integrating the tool into workflows through checklists or electronic decision support.

To reduce short-term PICC use, identify and address underlying drivers such as limited staff competency in peripheral IV placement, high failure rates, and challenges with difficult venous access. General strategies include enhancing staff training, utilizing visualization and ultrasound technologies, establishing specialized IV or difficult access teams, and improving securement practices to minimize complications and promote appropriate use of alternative devices.

PICC use is contraindicated in patients with advanced kidney disease (eGFR < 45 ml/min) due to the risk of future dialysis access failure, and alternative options like small bore central catheters (SBCCs) should be considered. Institutions should implement safeguards such as nephrology approval, EHR alerts, and collaboration with interventional radiology to guide appropriate vascular access decisions in this population.

To reduce complications associated with central venous catheters, promote single-lumen PICC use by default and require clinical justification for multi-lumen requests based on defined criteria. Engage pharmacists to explore alternatives for medication administration and consider switching to single-lumen devices for outpatient care when appropriate.