OBJECTIVES: Catheter-related thrombosis (CRT) is a complication associated with use of peripherally inserted central catheters (PICCs) that can result in therapy interruption, an increase in the cost of care, and patient consequences ranging from phlebitis to pulmonary embolism. In hospitalized patients receiving PICCs, thrombosis rates have been reported to vary between 5 and 15%. There are multiple modifiable (e.g., catheter size) and non-modifiable (e.g., cancer) risk factors for CRT and a multi-disciplinary approach can help to lower risk.

METHODS: A retrospective study was conducted within a 1200-bed health system including patients aged 18 years and older with PICCs placed by vascular access nurses. The study compared rates of CRT in patients before and after a multidisciplinary, multi-year intervention. This intervention involved reduction in 6 French (Fr) catheter use and switch to a manufacturer supplying 4 and 5 Fr double and triple-lumen PICCs, ultrasound guidance for measurement of catheter-to-vein ratio and improved visualization, and ECG navigation for catheter tip location conformation. A time series analysis was performed using R software Version 4.3.2. An economic model calculated economic impact based on results of the observational audit.

RESULTS: Across the health system, results demonstrated very low CRT rates of <1% in the post-intervention study period, compared with a baseline pre-intervention rate of 5.37%. The greatest reduction was attributed to elimination of 6-Fr PICCs as part of the intervention. For every 1,000 PICC placements, the model predicted cost savings exceeding $1M USD (i.e., $1,083,600) due to avoided thrombosis.

CONCLUSIONS: This retrospective study demonstrated that small improvements to controllable elements of catheter care administered to a broad patient population can result in significant reductions in the risk of a serious complication as well as associated costs. Further study is required to confirm benefits in larger populations, and to understand which situations could result in highest cost savings.