The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method

Abstract

Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients.

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

“…[6][7][8][9] Additionally, existing guidelines for device selection and placement recommend using the minimal number of device lumens to meet clinical needs. [10][11][12] Consequently, some hospitals have enacted policies that limit use of multilumen PICCs in order to prevent PICC-related CLABSI and DVT. For instance, 1 hospital simply stopped purchasing multilumen 6-French (Fr) PICCs and experienced a 50% decrease in rates of upper-extremity DVT.…”

Peripherally Inserted Central Catheters and Hemodialysis Outcomes

“…In both of these prior studies, 30%-50% of PICCs were placed for nonspecific indications, such as difficult vascular access (14,21). PICC placement enables blood sampling and continuous vascular access without frequent venipunctures or direct cannulation of central veins, and these conveniences contribute to their expanding popularity (22,23). Because PICC use has increased, potential concerns about bloodstream infections, thromboses, and stenoses of central and peripheral veins have emerged (11)(12)(13)24,25).…”

Developing, Implementing, and Evaluating a Multimedia Patient Decision Aid Program to Reform the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Protocol for Quality Improvement (Preprint)

“…Third, we surveyed 30 patients who received the consent process for the PICC procedure The questionnaire used for knowledge recall and knowledge retention was created based on recent guidelines for PICC [22][23][24][25][26][27][28][29][30][31][32] and included 3 "select one-answer" multiple-choice questions, 4 "select all that apply" multiple-choice questions, and 12 true/false questions. The knowledge recall questionnaire was administered within 4 -8 hours after the discussion between the vascular access team nurse and the patient and obtaining the signed consent.…”