Venous thromboembolism prevention: an innovative approach to improving quality and safety in a Neuro ICU

Purpose:
The purpose of this quality-improvement project on a Neuro ICU was to improve the PICC-related deep vein thrombosis (DVT) rates with a new peripherally inserted central catheter (PICC) for this high risk patient population. Infection rates and use of low dose Alteplase (Cathflo®) was also tracked.

Significance:
Preventing venous thromboembolism (VTE) in the critical care neuroscience patient can be challenging. With a DVT incidence of 6-40% (depending on the diagnosis), a multi-faceted approach of both pharmacologic and mechanical methods are often utilized as part of a prevention approach.

Strategy and Implementation:
Through extensive chart review of all patients who received a PICC line in the Neuro ICU in 2012, the partnership between a senior PICC nurse and a Neuro ICU nurse (with support from a pharmacist and infection control RN), yielded a nine month incidence rate of PICC-related DVTs as 17.7%. Fifty-two new BioFlo® PICC lines were placed at the bedside by trained PICC nurses in the Neuro ICU over the course of 4 months. Patients were closely followed throughout their inpatient stay until discharge for development of PICC-related DVTs. Both superficial clots and DVTs were counted for reporting purposes. Traditional VTE prevention techniques of pharmacologic and mechanical methods were also utilized as ordered by the provider. PICC line infection rates were tracked as well as the use of Cathflo® to restore catheter patency.

Evaluation:
A total of 4 clots were found over the 4 month timeframe for an overall incidence of 7.7% which demonstrated a 56% reduction in DVTs. Cost savings for this initiative are estimated to be at least $40,000 in treatment and monitoring costs. Other outcome measures were insignificant.

Implications for Practice:
Reducing the VTE risk for patients reduces their risk of mortality. As the third leading cause of death and most preventable hospital-acquired mortality risk for inpatients, the threat of pulmonary embolism and its precursor DVT can be minimized with a comprehensive and innovative approach to care.