Appropriate selection of PICC and Midline Catheters with New Vascular Access Consult in the Electronic Health Record

From the 2018 HVPAA National Conference

Anisha Ganguly (University Texas Southwestern Medical School), Muthusamy Anandkumar (Parkland Health and Hospital System), Deepak Agrawal (University Texas Southwestern Medical Center), Norman Mang (Parkland Health and Hospital System), Kavita Bhavan (University)


Midline catheters are preferred alternatives to PICC if intravenous access is required for <2 weeks, since they have a lower risk of infection, clots, and do not require XRays prior to use. At our hospital, many PICC lines were being placed  for indications requiring vascular access for <2 weeks.


Optimize selection of PICC and midlines through quality improvement initiative focused on multidisciplinary provider engagement, education and use of electronic medical record order sets.


An algorithm was developed to guide appropriate use of catheters, utilizing the published guidelines. A multidisciplinary team was then formed to lead a quality improvement initiative with a focus on both widespread education of best practice and development of new vascular access order set to improve clinical workflow. In the new order set, instead of requesting placement of a specific vascular catheter, the ordering provider places consult for vascular access. The vascular line placement nurse team has the autonomy to discuss with providers and decide between PICC and midlines based on established guidelines.


The multidisciplinary team leading this initiative began educational efforts in January, 2017 and the vascular access consult order set launched in the EMR in September,2017. The overall utilization of A PICC and Midline catheters is shown in the graph below. More midline catheters were placed after the order set was introduced. Retrospective cross sectional review showed 55 midline catheters were placed in September 2015 and >100 midline catheters placed in September 2017.


A targeted educational approach with multidisciplinary input along with a newly developed vascular access order set in EPIC has facilitated improved utilization of appropriate midline catheter use at our institution.

Implications for the Patient

Our intervention will decrease hospital costs associated with PICC lines and due of X Rays performed to determine appropriate placement. In addition, appropriate midline placement improves patient safety with the use of a less invasive procedure to establish vascular access. Our order set can be easily adapted by any institution.

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