Saving the Vein: Minimizing Early PICC Line Removal in Hospitalized Pediatric Patients

by Candice Palmisano

Coauthors: Candice Palmisano & Rebecca Barber

Other

Background– Peripherally inserted central catheters (PICC) lines are important for the management of medically complex pediatric patients. Indications for a PICC line include frequent blood sampling, rapid administration of intravenous (IV) fluids, IV fluids with extremes in pH, long-term antibiotics, vasoactive agents, in addition to multiple other intravenous medication needs. Additionally, PICC lines can minimize exposure to multiple venipunctures and repeated IV failure. While there is concern that PICC lines are associated with increased risk of infection, inconsistencies in determining "line necessity" or utilization of a standardized tool have led to premature PICC line removal and subjected patients to have a less stable access. In medically fragile children and those with chronic medical conditions vessel preservation is critical for these populations that will require medical treatments and medications for the duration of their life. Premature line removal has subjected patients to repeat PICC line insertions and iatrogenic harm, and increased costs.

Intervention – Creation and utilization of an evidenced based checklist used during daily patient rounding used by the multidisciplinary team. The evidence-based tool will help clinician’s determine if the patient meets criteria for being a difficult IV access patient. Difficult access patients are those patients with chronic medical conditions, two or more failed IV attempts and/or escalation of advanced modalities to gain IV access. Additionally, confirmation should be made prior to PICC line removal that a patient has an actual line infection. Guidelines suggest obtaining blood cultures from both the PICC line and from the periphery and correlating the patients clinical condition appropriately. The decision-making process for PICC removal would also involve a vascular access team consultation prior to PICC line removal. In this organization, a specialty vascular access team is responsible for approximately 95% of PIV’s placed and PICC line insertions and are on-site 24 hours a day for consultation on difficult access patients.

Outcomes – Expected outcomes of this evidence-based project are to help prevent premature line removal and minimize repeated venipunctures and failed PIVs allowing patients to complete prescribed medical therapies and reducing the exposure to painful procedures. This project will aide in vessel preservation and