Improving Quality by Decreasing Vascular Access Device Related Thrombosis Risk

Purpose:
Catheter related thrombosis is a serious complication of vascular access device placement.Recent studies have shown that terminal catheter tip location plays a significant role in the risk of thrombosis development. Our goal is to recognize and minimize thrombosis risk when placing these devices.

Significance:
As institutions partner with CMS and the CDC to reduce CLABSI, PICC usage has increased around the country. Though the benefits of PICC catheters are evident in clinical practice, thrombotic complications can arise and the costs in human suffering and length of stay can be significant.

Strategy and Implementation:
At Duke Medicine, we have transitioned from placing catheters that terminated in the subclavian vein to placing catheters that have the terminal tip in the distal portion of the superior vena cava at the right atrial junction. This transition is a part of our efforts to reduce PICC catheter related thrombosis and improve patient outcomes. We began by changing nomenclature and educating IV team staff about the most current evidence related to thrombosis risk. We then assembled a mutidisciplinary team within the clinical practice council and started a PDCA cycle. This presentation will discuss the various obstacles we anticipated and encountered during the transition as well as our outcomes and plans for continued improvement.

Evaluation:
We have decreased the use of catheters with suboptimal terminal tip locations by 95% and are beginning to note a decrease in thrombotic complications.

Implications for Practice:
This innovation has changed the way our workflow progresses and has increased the use of chest radiography for determining tip location. It has also brought to light educational opportunities for nurses and physicians in our institution with regard to vascular access standards of practice.