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Guidelines/Policies for appropriate PICC use & placement & national standards for number of PICCs placed

We are a 750 bed hospital that has developed a PICC team of 6 members and as of 1/28/07 will have 24h coverage.  Whille building our team, we placed 2,136 lines for 2006.  We also have a contract agency that places the PICCs we can't get to. I believe they placed >1,000 lines for the year.  Of course, as our team has grown, we have had to rely on them less, which was the goal in developing our team. So for 2006, we had >3,000 total PICCs placed for our facility. Our PICC team has an infection rate of 0.5% and since we have been using Sherlock and occasionally Navigator, have decreased our malposition rate from 15% to 8%.  For now, our team focuses on PICC placements, nursing/physician education, troubleshooting and 24h follow-up s/p PICC placements.

I have heard that average PICCs per bed/per year is 5-7, which would put us under the national standard.  Where does one get this information?  I would assume those of you that work in large/teaching university facilities would have a better grip on the norms/averages?   Upper management is now telling us we need to focus on lowering our PICC numbers with a focus on having a small "PIV IV team".  We currently screen our referrals for the reason for the PICC - ie... multiple sticks for PIVs, TPN, long term abx, chemo, etc.  as well as getting orders OK'd by nephrologist if is a dialysis patient. Currently we also ask if pt has a peripheral IV and determine if this is adequate for the type of therapy they are receiving. Also, we assess if the nurse has already attempted to start a peripheral and are usually told that pt have been stuck multiple times...from staff nurse up to the supervisors attempts.I would appreciate any input you can provide or pick your brains. Cheryl Kelley-We haven't talked with you in awhile and would like your input as well.....:) Thanks, Cindy Hunchusky-Harris Fort Worth(Texas) [email protected]

Gwen Irwin
I asked that question awhile

I asked that question awhile back.  Lynn Hadaway responded.  Hope I recall well enough what she told me and not misquote you, Lynn.  Jump in and correct if I do.

My understanding is that the number of 3-5 times the number of beds was obtained by looking at published studies by organizations that already had established programs evaluating patients for PICCs.  Their number of PICCs inserted were in the range of 3-5 times the number of beds.

 Gwen Irwin

Austin, Texas

I am making a wild guess

I am making a wild guess here that the administration's goal is to reduce costs. Therefore your goal would need to be to convince them that your PICC program is cost effective. The champions of the assessment advantage program have put together  pretty good presentations delinating the costs of multiple PIV's vs PICC placement. Depending on what PICC you are using, you may be able to get good support from your reps. In any case, I think there is a fair amount of literature out there supporting this theory.

It never hurts to throw in patient satisfaction (in fact a great motivator for administration, at least at our house). If you do Press Ganey scoring, or just even quote some other places scores, you can speak to the fact that IV issues is the No. 1 clinical dissastisfier amongst patients. Therefore, this also speaks to $$$.

Those numbers have been

Those numbers have been presented in several talks at AVA, etc and have been based on assessment of many hospitals PICC insertion programs. I can not quickly recall if Kathy Kokotis or Jim Lacy have actually published these numbers any where.

 It is relatively easy to look at your operational cost for insertion of a PICC (around $200-250) vs the operational cost for insertion of a PIV (around $32 to $38). If a patient has multiple sticks with a PIV it would only require about 6 sticks to equal the cost of a PICC. Please notice that I am talking about operational costs and not patient charges. Then look at the capitated fee structure. Just because you are doing multiple PIVs, there will not be an increase in the amount your facility will be reimbursed. A cost of 10 PIV = $380 vs the cost of one PICC at $250. Look at these figures as the percentage of the DRG. If a patient requires multiple PIVs, the hospital is loosing lots of money in these additional costs. Lynn 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

We also have more than 700

We also have more than 700 beds.  Our staffing and PICC/ PIV placements are as follows.  We usually have 24hr coverage with 1 RN doing the "difficult IV placements" on the 7a-7p shift and one RN doing PICC placements 7a-7p.  on PMs 7p-7a the sole RN does both.  We only have 4 FT RN's on 7a-7p and 1 FT and 1 PT RN for PM coverage; therefore, not every shift is covered 24/7.  We average 1500 PIV and 275 PICCs each month.


Las Vegas

How is that number obtained

How is that number obtained of 5 PICC lines per bed per year which is not low as I calculated that number as well as Jim Lacy did in 2003

I looked at the top 50 PICC line users in the United States who had a dedicated (full time) high-tech PICC team (MST & US usage).  Jim did the same

The numbers indicated at the time that 5 PICC lines were used per year per bed that was occupied and 4 if they were not occupied beds but hospital bed size.  That is a differnce.  I also found that 13% of admits per year got a PICC line

But that has now changed with the advent of the power injectable PICC lines and triple lumen PICC lines.  The number has now gone up as PICC lines are being used in the ICU more often

I believe I published that number in my article in JIN in 2004 on Cost containment

The key finding now is doing the CQI and I have found that it is important to identify the length of time it took to capture the PICC patient from admission versus the entire patient length of stay to show performance improvement and cost savings

I do know the THR system and I did the CQI database study there when the independent contractor was doing 100% of the PICC line.  I can tell you that the mean time to recognize a patient needed a PICC line was superior and I am sure it remains superior at 2.7 days overall.  The majority of your patients get identified in the first 72 hours of admit and the PICC line dwells for an average of 6-7 days.  The patient length of stay was ten days which is on the low end for the nation by the way.  I have to tell you that your facility had some of the best scoring for the nation on early assessment  PICC line patients are outliers by the way

I do believe the numbers at this THR system show that PICC lines decrease a patient's hospital length of stay and result in cost savings overall.  It would have been nice to have the before numbers on early assessment as we could have shown the significant performance improvement that was made in this institution with early assessment and high tech tools to insert PICC lines.  Your doctors are well versed on PICC line usage as well as the clinical staff at THR.  I was duly impressed by the results

This facility is performing early assessment of PICC lines and performing early discharge

Would I say you are over using PICC lines I would say no as I also did an analysis at the facility of diagnosis and infusate that got a PICC line and it was very targeted and appropriate

If you need further information let me know


Kathy Kokotis

Bard Access Systems

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