The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) initiative: A summary and review of peripherally inserted central catheter and venous catheter appropriate use

Abstract

Peripherally inserted central catheters (PICCs) are being selected for venous access more frequently today than ever before. Often the choice of a PICC, when compared with other vascular access devices (VADs), is attractive because of perceived safety, availability, and ease of insertion. However, complications associated with PICCs exist, and there is a paucity of evidence to guide clinician choice for PICC selection and valid use. An international panel with expertise in the arena of venous access and populations associated with these devices was convened to clarify approaches for the optimal use of PICCs and VADs. Here we present for the busy hospital‐based practitioner the methodology, key outcomes, and recommendations of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) panelists for the appropriate use of VADs. Journal of Hospital Medicine 2016;11:306–310. © 2015 Society of Hospital Medicine

Complications related to totally implantable venous access devices in children and adults following lung transplantation

“…TIVADs are preferred over PICCs for longer duration of intravenous therapy due to the lower incidence of infectious, thrombotic, and mechanical complications . In prior studies of cystic fibrosis patients, for example, who comprised the majority of our study cohort, all‐cause TIVAD‐related complications range from 0.43 to 0.91 per 1000 catheter‐days and infectious complications range from 0.15 to 0.26 per 1000 catheter‐days . By contrast, PICC complications have been reported in up to 20% of patients with cystic fibrosis who have indwelling PICCs for a duration of 2‐3 weeks .…”

“…The decision to use TIVADs in patients with advanced lung disease is dependent on many factors, including frequency and duration of intravenous treatments, patency of peripheral veins for intermittent therapy, and patient preference . TIVADs are preferred over PICCs for longer duration of intravenous therapy due to the lower incidence of infectious, thrombotic, and mechanical complications . In prior studies of cystic fibrosis patients, for example, who comprised the majority of our study cohort, all‐cause TIVAD‐related complications range from 0.43 to 0.91 per 1000 catheter‐days and infectious complications range from 0.15 to 0.26 per 1000 catheter‐days .…”

“…Available venous access devices include peripherally inserted central venous catheters (PICCs), tunneled central venous cuffed catheters, and totally implantable venous access devices (TIVADs), also known as venous ports. TIVADs are the preferred venous access device for longer duration of therapy and have the benefit of reduced infection and mechanical complications rates compared to PICCs and tunneled central catheters …”

Recurrent migration of peripherally inserted central catheter into the azygos vein

“…Peripherally inserted central catheter (PICC) is indicated for a variety of conditions including difficult peripheral intravenous access, administration of long-term intravenous antibiotics, total parenteral nutrition, infusion of chemotherapies and frequent phlebotomy 1. PICC insertion is routinely performed in both outpatient and inpatient settings.…”

Application of peripherally inserted central catheter in acute myeloid leukaemia patients undergoing induction chemotherapy

“…In the past, an implantable port and centrally inserted external catheter were the conventional central venous access devices. However, peripherally inserted central catheters (PICCs) have increasingly been used for intermediate‐term access over the last few years (Woller, Stevens, & Evans, ).…”