Single-lumen catheters decrease complications, increase savings

Replacing dual-lumen catheters with their single-lumen counterpart for most indications has decreased reinsertion rates and saved thousands of dollars for the McGill Health Centre (MUHC), according to a study published in the November issue of the Journal of the American College of Radiology.

Peripherally inserted central venous catheters (PICCs) can add to financial strains of hospitals and health care systems as vascular access is a resource-intensive practice. It’s estimated that more than 2,000 PICCS are inserted each year at MUHC in Montreal.

The study’s lead author, Jeremy O’Brien, MD, of MUHC, and colleagues explained the repercussions of this rampant problem at their facility.

“Lumen number and decisions about catheter replacement were undertaken by the treating physicians, with little input from the interventional radiology team,” they wrote. “PICCs with more than one lumen were often inserted when not indicated, >50% of the time, despite guidelines by both nursing associations and the Centre for Disease Control recommending the insertion of catheters with a minimum number of lumens because of increased risk for central line–associated bloodstream infection (CLABSI) and catheter-related deep vein thrombosis.”

Not only does the inappropriate insertion of multiple-lumen catheters create serious health risks for patients, but it also increases costs and hospital stays. O’Brien and colleagues thus created a study in which catheter selection was streamlined on the basis of clinical unit need in order to determine its effect on complications and costs.

A full-time registered nurse specialist (CNS) was hired to analyze and transform the vascular access program at the MUHC. The CNS also trained nurses on appropriate catheter maintenance that was previously nonstandardized. Specific requests for multiple lumens were discussed with the interventional radiology team. Clinical and cost data were prospectively collected between May 2011 and January 2012 for all PICC insertions.

After analysis and implementation of the streamlined system, single-lumen catheters were inserted by default unless otherwise specified. About 50 percent of PICCs inserted are now 4-French single lumen catheters versus the near 100 percent figure prior to the start of the program. Confirmed or suspected CLABSI rates significantly dropped with single-lumen catheters. MUHC’s overall savings from this change have been about $1.1 million.

“Taken together, these reductions in both clinical complications and economic costs demonstrate that small, targeted changes in practice management can make a large impact in modern health care,” wrote the study’s authors.