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

Abstract

BackgroundThe Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.MethodsA quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (≤5 days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).ResultsAmong 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, p<0.001) while complications decreased to 10.7% (absolute difference 4.0%, p=0.001). Compared with patients with inappropriate PICC placement, appropriate PICC use was associated with a significantly lower odds of complications (OR 0.29, 95% CI 0.25 to 0.34), including decreases in occlusion (OR 0.25, 95% CI 0.21 to 0.29), CLABSI (OR 0.61, 95% CI 0.46 to 0.81) and VTE (OR 0.40, 95% CI 0.33 to 0.47, all p<0.01). Patients with appropriate PICC placement had lower rate of complications than those with inappropriate PICC use (incidence rate ratio 0.987, 95% CI 0.98 to 0.99, p<0.001).ConclusionsImplementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.

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

“…In addition, these devices were more often associated with major complications. These findings are comparable with findings from North America, where the major drivers of inappropriate PICC use are use of multi-lumen devices and short-term device use 10 11. This gap presents an opportunity for practice improvement and patient safety.…”

“…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. Although these findings provide important insights in the USA and Canada, little is known about patterns of PICC use, device appropriateness and outcomes in developing nations 10 11. Specifically, less is known about PICC use and outcomes in South American nations.…”

“…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.…”

“…Data from two contemporary meta-analyses reflecting modern insertion approaches and current practices show that smaller-diameter PICCs, single-lumen devices and proper tip location can lead to fewer harmful events 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 8–11. 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.…”

Replicating and publishing research in different countries and different settings: advice for authors

“…In this paper, Rabelo-Silva and colleagues from the PICC-Brazil Research Group present a descriptive study of the patterns, appropriateness and outcomes associated with peripherally inserted central catheters (PICCs) in 16 Brazilian hospitals 2. The study used the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to assess appropriateness, an approach previously used in the USA3 and Canada 4. Complications such as deep vein thrombosis, central line-associated bloodstream infection and line occlusion were prospectively recorded by trained staff at each hospital.…”