Electronic decision support tool ensures appropriate midline catheter and single-lumen PICC insertion

Previous studies have shown that both midline catheters and single-lumen PICCs have lower complication rates (e.g. venous thromboembolism [VTE] and central line–associated bloodstream infection) as compared to multi-lumen PICCs. Despite the known risks of peripherally inserted central catheters, there is substantial interhospital variability in their use.

Tyler J. Anstett, University of Colorado School of Medicine, Aurora, Colorado, USA, and colleagues aimed to examine the effects of an embedded electronic health record (EHR) order for increasing the use of midline catheters over PICCs when appropriate and decreasing PICC lumens when a PICC is necessary.

For this purpose, the researchers performed an observational trial at a single academic medical centre for 3 years to examine the effects of an embedded EHR order, which guided providers to select the appropriate catheter based on indication and expected duration of use. In the 11-month preintervention period, about 2300 catheters were placed and nearly 6500 were placed in the 25-month postintervention period.

The quasi-experimental, interrupted time series designed study included hospitalized adults who received a midline or PICC during clinical care.

The study led to the following findings:

• During the study period, a total of 8758 midline and PICCs were inserted.
• A statistically significant increase in the insertion of midline catheters was observed during the intervention.
• In parallel, single-lumen PICC insertion as a proportion of all PICCs also increased after the intervention.
• Results were consistent across multiple disciplines, including internal medicine, surgery, and intensive care.
• After considering the hospital census, total PICC and midline utilization rates and rates of complications did not change over time.
• An increase in catheter exchanges from less to more invasive devices occurred.

Results were consistent across multiple service specialities (e.g., surgery, internal medicine, intensive care), but oncology use didn't change. Line placement rates and complication rates were unchanged for all PICCs plus midlines.

The findings indicate that a fairly simple intervention can lead to the more appropriate use of single-lumen and midline PICCs, although its findings might not apply to oncology patients who often need central access for multiple infusions.

"Our findings revealed that the implementation of electronic decision support to inform the appropriate use of catheters led to a more appropriate insertion of catheters and single-lumen peripherally inserted central catheter," the researchers wrote.

"We welcome the dissemination of this single, effective intervention to examine efficacy in other hospital settings," they concluded.

Reference:

Bredenberg, E., Atwater, R., Grimm, E., Chopra, V., Shamburger, C. D., & Anstett, T. J. (2023). Promoting appropriate midline catheter and PICC placement through implementation of an EHR-based clinical decision support tool: An interrupted time-series analysis. Journal of Hospital Medicine, 18(6), 483-490. https://doi.org/10.1002/jhm.13093