122 - The Buck Stops Here. PICC Line Utilization: Stewardship Is Not Only About Antimicrobials Any More

Background: The Choosing Wisely guidelines recommend avoiding placement of PICCs in patients with GFRs less than 45. A recent study found that 1 in 4 PICCs are placed in patients with CKD and the majority of PICCs are for antibiotics. Recent studies have demonstrated early and safe transition from IV to PO antibiotics forgoing PICC use. To our knowledge no studies assess opportunities to reduce PICC use and adverse events through infectious disease. This study aims to identify opportunities for improved PICC utilization.

Methods: This was a single center retrospective analysis of all PICCs in adults from January 2017 to October 2019 at the University of Nebraska Medical Center (UNMC). Data was abstracted via chart review including demographics, index hospital stay, PICC details, PICC indication(s), PICC duration, GFR prior to PICC placement. If present, antimicrobial indication, and infection information.

Results: 211 patients were included. PICC lines were placed in 18.0% (n=38) of patients with GFR < 45. 123 PICCs were for antibiotics. Breakdown of IV antibiotic duration in Figure 1. Infection types treated in < 7 days noted in Figure 2. Infection types treated in 7 – 13 days noted in Figure 2. There was a statistically significant finding of increased duration of antibiotics when infectious disease was consulted with 90.0% (n=63) of cases 14 + days, 60.9% (n = 14) for 7 – 13 days, and 56.7% (n=17) in cases < 7 days (p=0.002).Figure 1
Figure 2
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Conclusion: Infectious disease providers are trained to consider antimicrobial stewardship. Antimicrobials directly impact therapeutic choices for patients. However, less frequently considered is the insertion of PICCs in patients with tenuous renal function. Given the prevalence of PICCs in patients with GFR < 45, contrary to guideline recommendations, as well as increasing evidence for use of shorter durations and oral antibiotics for treatment there is opportunity for quality improvement and intersectional synergy.