Nudging to select single-lumen over multiple-lumen peripherally inserted central catheters (PICCs) in a large safety net system

Daniel Alaiev, Mona Krouss, Sigal Israilov, Lara Musser, Joseph Talledo, Nessreen Mestari, Amit Uppal, Theresa Madeline, Gabriel Cohen, Nathaniel Bravo, Marialeah Cervantes, Daniel Contractor, Peter Alacron Manchego, Komal Chandra, Milana Zaurova, Surafel Tsega, Hyung J. Cho

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Peripherally inserted central catheters (PICCs) are increasingly used for vascular access in inpatient settings. Compared to multilumen PICCs, single-lumen PICCs carry a lower rate of complications, including central-line-associated bloodstream infection and thrombosis. Despite this, multilumen PICCs are still overused. Methods: This quality improvement initiative was implemented across 11 hospitals at New York City Health + Hospitals safety net system. The electronic health record (EHR) interventional radiology or vascular access team consultation orders were modified to allow for lumen choice, with default selection to a single-lumen PICC. Results: Average single-lumen PICC utilization increased by 25.5%, from 44.4% to 69.9% (P <.001). CLABSI rates had a nonsignificant reduction by 26.7% from 2.44 to 1.79 infections per month (P =.255). Among provider types in the postintervention period, single-lumen PICC utilization ranged from 67.7% for advanced practice providers to 82.4%-94.6% for physicians. Among provider specialties, utilization ranged from 31.8% for neurology to 97.7% for orthopedics. Additionally, there was large variation in pre- and postintervention differences in utilization by hospital. Conclusions: We successfully increased single-lumen PICC utilization across all 11 safety net hospitals. This expands on previous work on improving single-lumen PICC use and use of default nudges in large, resource-limited settings. Further study is needed to examine variation among provider types, specialties, and hospitals.

Original languageEnglish
JournalInfection Control and Hospital Epidemiology
StatePublished - 24 Mar 2023


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