Venous thromboembolism prevention: an innovative

approach to improving quality and safety in a Neuro ICU

STEPHANIE COX BSN RN CCRN AND KAREN WHEELER BSN RN VA-BC STEPHANIE.COX@UCHEALTH.ORG; KAREN.WHEELER@UCHEALTH.ORG

Background Methods Implications for Practice

• 2.5 million deep vein thrombosis (DVTs) and 600,00 PEs
are diagnosed every year in the United States
• PE is the most common preventable cause of death
among hospitalized patients
• Vichow’s triad of venous stasis, hypercoaguability, and
vascular injury “is more prominent in the neuroscience
intensive care population” 1
• Neuro ICU patients may have increased expression of
Virchow’s triad components leading to the development of
a PICC-related DVT 2
• The evidence supporting the trial PICC suggesting it will
reduce DVTs is based on the technology associated with
the device
• 9 month chart review completed by a PICC charge RN
revealed a PICC-related DVT rate of 17.7%
• Trial using a new PICC was implemented for 4 months
• PICC RN team placed 52 of new PICCs in 51 patients from
Dec 2012 to Mar 2013 (trial PICC)
• 74 PICCs were placed April-May 2013 (previous standard of
care PICC line)
• Reports on DVT, CLABSIs and CathFlo® use obtained from
PICC team, Infection Control and Pharmacy
• Standard of care remained constant regarding patient
selection for PICC, nursing care, management of the device
PICCs and DVTs in the Neuro ICU
73 74
68
52
• PICC-related DVTs were reduced during the new device
trial
• Reducing the DVT risk for patients reduces risk of
associated morbidity and mortality
• Venous thromboembolism prevention is a Joint
Commission core measure and a Meaningful Use
measure for inpatients
• Exploring technology to reduce DVTs may be an
important intervention in the care of high risk patients
• Cost: PICC associated DVTs are estimated to cost
$15,973 and lengthen LOS by 4.6 days 3
• Cost savings from this trial estimated to be $79,865
• Most Neuro ICU patients require a multi-faceted
approach to minimize DVT risk:
 Progressive mobility
 Mechanical thromboembolism prevention
 Pharmacologic prevention when appropriate

14 11 4 12
JAN-MAY '12 MAY-SEPT '12 PICC TRIAL DEC-MAR APR-MAY '13
Acknowledgements
'13 • The nurses, physicians and staff of the Neuro ICU and Neuroscience
units
# PICCs placed # DVTs • The University of Colorado hospital PICC team RNs
Purpose Outcomes
• AngioDynamics, Latham, NY for their support of the trial
• Mary Beth Flynn Makic RN, PhD, CNS, CCNS, FAAN, Research Nurse
Scientist, Critical Care
• The purpose of this quality-improvement project was to • DVT Rates:
improve the PICC-related DVT rates by using a new PICC – New PICC: 4 DVTs overall incidence of 7.7% Selected References
line device. – Standard PICC: 12 DVTs overall incidence of 17.2% 1. Palamone, J., et al., 2011. Journal of
Neuroscience Nursing, 43(6), 308-314.
• Infection rates and use of low dose Alteplase (Cathflo®) to • No CLABSIs were reported with the new PICC 2. Wilson, T., et al., 2012. Intensive Care
restore catheter patency was also tracked. • CathFlo® use was similar with both PICC devices
Medicine, 38, 272-278.
3. Evans, R.S., et al., 2013. Chest, 143(3),
• The PICC device was placed only in patients in the Neuro • The PICC nurses did not report any adverse events with 627-633.
ICU that required a PICC as part of their standard PICC placement during the product trial
4. Image provided courtesy of AngioDynamics.

treatment. • Dwell days: average 16.4 +/- 16.3 for trial PICCs