Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data

Abstract

BackgroundPeripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).MethodsThis was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use.ResultsAmong 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC.ConclusionsClinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.

Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals

“… 10 In a study by investigators in Ontario, applying MAGIC to measure appropriateness of catheter use in a provincial database was found to be feasible with a substantial proportion of PICCs deemed either uncertain or inappropriate—suggesting room for improving quality of care. 20 Similarly, a national study of Medicare recipients found that the publication of MAGIC was associated with reductions in overall PICC use in the US. 21 The present study advances these findings by showing a significant association between PICC appropriateness and complications across multiple hospitals.…”

Competência de enfermeiros para uso do cateter central de inserção periférica em adultos1/ Nurses’ competence to use peripherally inserted central catheters among adults1

“…Essa atitude favorece o desperdício do material por uso inadequado ou vencimento da validade. Pesquisadores recomendam intervenções direcionadas para reduzir o uso inadequado de PICC, considerando os custos e complicações potenciais associadas à colocação desse cateter (14) .…”

“…O uso do PICC por uma equipe de inserção especializada liderada por enfermeiras, com material de boa qualidade, uso protocolos para manutenção e cuidados e implementação das iniciativas de melhoria contínua de qualidade pode resultar em redução na incidência de complicações maiores, como infecções da corrente sanguínea relacionadas ao cateter e trombose venosa profunda (17;18) . Analisando 3479 colocações de PICC durante a hospitalização de pacientes de medicina interna geral, pesquisadores observaram que pouco mais da metade (53%) tiveram colocação totalmente adequada (14) .…”

Patterns, appropriateness and outcomes of peripherally inserted central catheter use in Brazil: a multicentre study of 12 725 catheters

“…6 7 Furthermore, with the publication of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) guidelines, the ability to examine appropriateness of PICC use at hospitals has emerged. [8][9][10][11] Findings from the USA, for example, have found that inappropriate use of PICCs often occurs in patients with chronic kidney disease (CKD) and in patients where PICCs are used for short duration, such as those with difficult venous access. Likewise, a study conducted by Verma et al in five academic hospitals in Toronto, Canada found that inappropriate PICC use most often occurred in patients with CKD.…”