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Improved Care and Reduced Costs for Patients Requiring Peripherally Inserted Central Catheters: the Role of Bedside Ultrasound and a Dedicated Team

Malcolm K. Robinson, MD^*, Kris M. Mogensen, MS, RD, LDN, CNSD^*, Gina F. Grudinskas, MMS, PA-C^*, Sharon Kohler, MSM, RN, CRNI and Danny O. Jacobs, MD, MPH

From the Departments of ^* Surgery and Nursing, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts; and the Department of Surgery, Duke University School of Medicine, Durham, North Carolina

Correspondence: Malcolm K. Robinson, MD, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Electronic mail may be sent to mkrobinson{at}partners.org. Presented in part at the third annual Nutrition Week, February 11, 2004.

Background: We conducted a prospective quality assurance (QA) study to determine if a team dedicated to placing peripherally inserted central catheters (PICCs) would improve patient care and reduce costs. Methods: In April 2000, a dedicated team of physicians, physician assistants, nurses, and interventional radiologists (IR) was established to coordinate and approve all PICC placements at our hospital. Ultrasound (US) became available in November 2000 to assist with bedside PICC placement. A QA database was created allowing data from 3 time periods reflecting initiation of the PICC service (April–June 2000), initial implementation of bedside US-guided PICC placement (October–December 2000), and the current service (October–December 2002) to be analyzed and compared. Results: For all time periods analyzed, the PICC team found that one-third of PICC requests was inappropriate and, therefore, disapproved placement. With addition of US, the bedside PICC placement rate increased to 94% compared with 73% at service initiation. This was associated with an overall 80% decrease in average patient waiting time for a PICC, facilitating more timely discharges from the hospital. Finally, placement costs were reduced by 9% six months after initiation of our service and by 24% after US became available. Conclusions: A dedicated PICC team improves patient care by preventing inappropriate PICC placements and decreasing patient waiting times. A PICC team with US capability also reduces costs by minimizing expensive use of IR facilities and reducing hospital lengths of stay. A dedicated PICC service should become the standard of care for all hospitals with high-volume PICC use.

Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 5, 374-379 (2005)
DOI: 10.1177/0148607105029005374


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