Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria

Abstract

In a multihospital quality improvement project, implementation of MAGIC improved PICC appropriateness and reduced complications to a modest extent. Given the size and resources required for this study, future work should consider cost-to-benefit ratio of similar approaches.

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

“…Advanced chronic kidney disease (stage 3b or greater, estimated glomerular filtration rate (eGFR) less than 45 mL/min/1.73 m 2 ) affected 23% of patients who had PICCs placed 8. At one Michigan hospital, a resource-intensive multimodal intervention based on MAGIC recommendations led to a small reduction in inappropriate PICC use 9. Our research builds on this existing literature.…”

“…A large multicentre study in Michigan has highlighted that PICC use varies across hospitals,6 and PICC placement is often inappropriate, particularly because of short duration7 or use in patients with chronic kidney disease 8. An intervention based on MAGIC criteria modestly reduced inappropriate PICC use at one site 9. However, the appropriateness of PICC use outside of Michigan has not been well described, and patient characteristics associated with inappropriate use are not known.…”

Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety

“…Increasing number of lumens and catheter size, for example, are well recognized predictors of PICC-related complications [14,15]. Conversely, efforts to reduce the number of lumens has led to improvements in complications, including bloodstream infection [16,17,18].…”

“…In some notable exceptions, health institutions have developed their own PICC quality registry, regularly benchmarking of complication rates within and between facilities, and over time, in their own system have led to realisation that innovation is needed [48]. Where established, these have been able to identify internal complication rates, as well assess the success of changes in PICC types for example of reduced use of triple lumen devices, that was associated with reduced thrombosis rates [17]. External commercial registries are also available (cvadregistry.com).…”

Rigorous evaluations of evolving interventions: can we have our cake and eat it too?

“…In this issue of BMJ Quality and Safety , Swaminathan and colleagues11 present a rigorous evaluation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) QI intervention, intended to reduce adverse events stemming from the insertion of peripherally inserted venous central catheters (PICC). PICCs have become ubiquitous as a substitution for a central intravenous line when patients need longer term central intravenous access, but clinicians often order them unnecessarily or order inappropriate types—for example, a double-lumen PICC when a single-lumen PICC would work just as well and carry a lower risk of complications.…”