Peripherally Inserted Central Venous Catheters (PICCs): An Opportunity for Antimicrobial Stewardship

Abstract

Background PICCs are often used in hospitalized patients who require prolonged intravenous (IV) antibiotic therapy. PICCs offer the advantage of ease and safety of insertion over traditional central venous catheters (CVCs) but still carry the risks of venous occlusion, phlebitis, dislodgement and central line associated blood stream infection (CLABSI). The objective of this analysis was to determine the impact of an ASP’s prospective audit and feedback when PICCs are ordered for antibiotic therapy. Methods Pharmacists from the Antimicrobial Stewardship Program (ASP) and Nurses from the PICC team reviewed the electronic medical record of patients ordered a PICC for IV antibiotics to determine whether either antibiotic therapy could be changed to the oral route or if therapy was complete per current infectious disease treatment guidelines. If either alternative to the PICC was approved by the ASP physician, the medical team was contacted to discuss discontinuation of the PICC order as well as the antibiotic recommendation. Results From January 1, 2016 through March 30, 2017, placement of 35 PICCs was prevented through prospective Stewardship review of PICC orders indicated for antibiotic use. A total of 361 PICC days and 378 IV antibiotic days of therapy (DOT) were avoided. Antibiotic therapy was stopped for 6 patients; 27 patients were prescribed an oral antibiotic alternative including 9 patients who were receiving IV vancomycin. For the 35 patients where a PICC was not placed, $8,700.00 to $10,380.00 was avoided in materials utilized for catheter placement and approximately 52 hours in IV nursing time was avoided for PICC placement. Additionally, approximately $14,400.00 in antibiotic expenditures was also avoided. Conclusion The opportunity exists for ASPs to reduce IV antibiotic DOT, avoid patient risk for CLABSI and reduce the cost of hospitalization and PICC nurse workload through screening PICC orders for IV antibiotic therapy.