| Institution: | 1. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT;2. Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305;1. Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan;2. Quantitative Methods Program, Institute for Social Research, University of Michigan, Ann Arbor, Michigan;3. Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan;4. Patient Safety Enhancement Program, VA Ann Arbor Health System, Ann Arbor, Michigan;5. St. Joseph’s Health Center, Ypsilanti, Michigan;6. PICC Excellence, Hartwell, Georgia;7. Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan |
| Abstract: | PurposeTo assess the cost-effectiveness of peripherally inserted central catheter (PICC) placements using an ultrasound and electrocardiogram-guided system versus external measurements and confirmatory chest X-rays (CXRs).Materials and MethodsSixty-eight guided PICC placements were performed in 63 outpatients (mean age, 43 ± 13 years; 50% male) and compared to 68 propensity score-matched PICC placements (mean age, 44 ± 13 years; 56% male) performed using external measurements by the same operators. Post-placement CXRs were used to confirm final catheter tip positioning. Cohorts were compared in terms of repositioning rates, desired tip positioning rates (in the lower third of the superior vena cava or at the cavoatrial junction), and estimated cost per PICC positioned as desired using manufacturer quotes, Medicare reimbursement rates, and hourly wages for staff time. Agreement between tip positioning according to the guided system versus CXR was also assessed.ResultsGuided PICC placements required less repositioning (1.5% vs 10.3%, P = .03) and resulted in more catheters positioned as desired (86.8% vs 67.6%, P = .01) than the external measurement approach. The cost per PICC positioned as desired was lower for guided placements ($318.54 vs $381.44), suggesting that the guided system was cost-effective in this clinical setting. Guided system-CXR agreement for tip position was poor (κ=0.25, P = .002) due to tips being slightly farther from the cavoatrial junction on CXR than indicated by the guided system.ConclusionsThe guided PICC placement system was cost-effective in outpatients treated by a single division of interventional radiology at an academic institution. |
