The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was to define indications and appropriate practices for peripherally inserted central catheters (PICC) use; however, MAGIC recommendations virtually reduced the use of PICC in hospital settings, including critical care. The aim of this review is to present an assessment of the MAGIC guidelines, considering contemporary evidence to date. The validity of the MAGIC recommendations and their applicability to current practice are called into question given important concerns with the methodology for their development (e.g. high volume of clinical scenarios for evaluation) and the supporting evidence used. There is a considerable amount of contemporary evidence not considered in MAGIC that reports on evolving practices, techniques, and technologies targeted to reduce complications associated with central venous access devices (CVADs). Recent evidence dictates that CVADs are necessary in the intensive care unit (ICU), and that PICCs are a safe, reliable, and appropriate type of central lines, which cannot be replaced in several ICU situations. In light of evolving evidence and practice, as well as the methodological concerns identified, the MAGIC guidelines should be revisited. It is also recommended to create a clinical assessment tool that identifies potential uses of specific CVADs, based on patient needs. The choice of the CVAD should be based on unique clinical considerations and current scientific evidence, not on fears informed by antiquated data.
Highlights
Fifty-six studies were included in a systematic literature review. PICCs were compared to CICCs and PIVCs for short/intermediate-term use in Europe. Several efficacy and safety benefits were shown with PICCs. Limited evidence showed higher costs with PICCs.
of complications avoided. Results: From the age of 40 years to death, patients using hydrophilic coated catheters avoided on average per person 16 symptomatic UTIs, 0.6 events of bacteremia, 0.7 events of epididymitis and 0.7 events of strictures compared to patients using non-coated catheters. This translated into total savings of $9,714 per patient over a lifetime horizon. The cost per hydrophilic catheter could be increased by 15% and still result in cost-savings. ConClusions: At the same reimbursement level, the hydrophilic coated catheter was found to result in both health benefits and substantial cost-savings compared to the non-coated catheter.
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