PICC line trends and cost effectiveness

Transcription

1 PICC line trends and cost effectiveness Poster No.: C-0656 Congress: ECR 2015 Type: Educational Exhibit Authors: C. O Brien, P. Govender, W. Torregiani, O. Doody; Dublin/IE Keywords: Epidemiology, Audit and standards, Fluoroscopy, Interventional vascular DOI: /ecr2015/C-0656 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11

2 Learning objectives Peripherally inserted central catheters (PICC lines) are the most commonly requested procedure in most interventional radiology departments (IR). They are essential to patients who are undergoing prolonged Intravenous treatment for antibiotics, chemotherapy and parenteral nutrition. Once placed, PICC lines supersede peripheral IV access making treatment more comfortable for the patient. In our IR department (Tallaght University Teaching Hospital) there has been a steady increase in the number of PICC lines requested between 2009 to In this audit we set out to explore the reasons behind the rapid growth of PICC line referrals and to examine the cost effectiveness of a Radiology lead PICC line service. We also assessed the impact of PICC lines on a patient's hospital stay. Background Peripherally inserted central catheters are traditionally placed in a peripheral vein at the elbow in the antecubital fossa and travel within the vein (basilic, cephalic or brachial) along the arm via the axillary vein and subclavian vein to terminate in the superior vena 2 cava or caval-atrial junction as demonstrated in figure 1. Page 2 of 11

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4 Fig. 1: Schematic diagram of a PICC line with the tip at the caval-atrial junction. References: Radiology, AMNCH, Tallaght Hospital, Dublin Ireland, AMNCH Tallaght Hospital Dublin Ireland - Dublin/IE FIG 2. Demonstrates a standard dual lumen PICC line. Fig. 2: Dual lumen PICC line References: Radiology, AMNCH, Tallaght Hospital, Dublin Ireland, AMNCH Tallaght Hospital Dublin Ireland - Dublin/IE There has been a steady rise in the amount of PICC lines placed in most Radiology departments in Europe; Interventional Radiology often delivers this service. In this study we carried out a retrospective study of all the PICC lines placed in the interventional department in Tallaght University Hospital, Dublin between January 2009 to December 2013 inclusive. The mean age of the patients was ~46 years in a range of 6 years to 90 years of age. We demonstrated a twofold increase in the number of PICC lines Page 4 of 11

5 requested from 2009 to In this study we explored the reasons for the growth and the associated cost effectiveness of PICC lines. Images for this section: Fig. 2: Dual lumen PICC line Page 5 of 11

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7 Fig. 1: Schematic diagram of a PICC line with the tip at the caval-atrial junction. Page 7 of 11

8 Findings and procedure details We performed a retrospective audit on the number of PICC line procedures performed in a university teaching hospital over five years, from January 2009 to December 2013 inclusive. In 2009, only 257 PICC lines were placed, this has steadily increased to a number of 472 in There was a steady rate of PICCs placed in at and average of 237 a year. The year 2013 demonstrated a doubling in the number of PICC lines placed. This significant increase was felt to be due to the advent of a new local nurse led outpatient intravenous treatment service and a lower threshold for referral. Technical success was 99 percent (470 from 472). Below is a graph illustrating the linear growth of PICC line placement from Fig. 3: Liner curve demonstrating the exponential growth of PICC line placements from January 2009 to January 2014 References: Radiology, AMNCH, Tallaght Hospital, Dublin Ireland, AMNCH Tallaght Hospital Dublin Ireland - Dublin/IE We analysed the referral sources in our department and demonstrated that the medical service referred most patients followed by the surgical service. Year Medicine surgery Oncology HaematologyICU Others Page 8 of 11

9 Table demonstrating the referral pattern from *Others represents an unknown referral source, orthopaedics and paediatrics. The complication rate associated with PICC lines is very low but includes: infection, phlebitis, central vein thrombosis, pain, leakage at the site and extremely rarely catheter 1. tip embolisation In this study the infection rate was 2% and the occlusion rate was 11% within 2 weeks of placement there were no reported cases of leakage, pain or catheter tip embolisation. PICC line placement has proven to be cost effective when compared to tunnelled central 2. venous catheters (CVCs) or implanted vascular ports The complications associated with PICC lines are also less costly to treat when compared tunnelled CVCs; for 4. example a pneumothorax or a haemothorax The cost of a CVC induced haemothorax 4 is reportedly $8,300. PICC lines are also easier and less costly to remove with lower 4 associated complications compared to CVCs. A cost assessement in our IR department demonstrated that the cost of a PICC line (excluding manpower) included: euro per PICC line, 3.00 euro per stat-lock, euro per sterile pack and 0.86 euro per disposable tourniquet. The total price was estimated at euro per PICC line this is counterbalanced in patients who are eligible for outpatient IV treatment by an estimated cost saving of 700 euro for an overnight inpatient stay. PICC lines are a safe and reliable method of delivering IV treatment; post placement of a PICC line patients are less likely to miss doses of crucial medicine secondary to a malfunctioning peripheral IV line. In our audit we calculated a result of early discharge in 23% of patients. 8% of patients required avoidance of admission with treatment performed completely on a outpatient nurse led basis. This again demonstrating the cost effectiveness and impact of PICC lines on patients hospital stay. Conclusion In this audit we have demonstrated the reason for a twofold increase in the number of PICC lines placed from inclusive: Page 9 of 11

10 A new outpatient nurse led IV treatment scheme for patients on prolonged courses of antibiotics or chemotherapy. Increased access to interventional radiology. A lower threshold for referral. We have also demonstrated that PICC lines are cost effective and improve patient outcomes: The cost of PICC lines are significantly less then that of tunnelled CVCs. PICC lines enable outpatient IV therapy resulting in less inpatient overnight stays. PICC lines are reliable, easy to use and result in less missed doses of crucial medicine. Thus improving patient outcomes. Despite the associated complications with PICC lines their overall benefit outweighs the risks when compared to other central venous catheters. Personal information References 1. Peripherally Inserted Central Catheters: A Report of 2506 Catheter Days STEPHEN C. LOUGHRAN, MSN, RN, CCRN, AND MARCELLO BORZATTA, MD, FACS. From the Mission Hospital Regional Medical Center, Mission Viejo, California. JPEN VOL 19, No PICC related thrombosis: Pathophysiology, incidence, morbidity and the effect of ultrasound-guided placement technique on occurance in cancer patients. Ms Meinir Elen Hughes, RGN, PGCE, MSc. Journal for the association of vascular access, 2011, VOL 16 No A New Perspective for PICC line Insertions Cost Effectiveness and Outcome Associated with an Independant PICC Service. John Davis, Kathy Kokotis. Journal for the association of vascular access 2004 Vol 9, Issue An observational study of periphrally inserted central catheter (PICC)-related complications amongst oncology patients. Mary Fairhall "A thesis submitted to Victoria Page 10 of 11

11 University of Wellington in partial fulfillment of the requirements for the Degree of Master of Arts (Applied) in Nursing" Victoria University of Wellington, Page 11 of 11