Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

Paje, David; Conlon, Anna; Kaatz, Scott; Swaminathan, Lakshmi; Boldenow, Tanya; Bernstein, Steven J.; Flanders, Scott A.; Chopra, Vineet

doi:10.12788/jhm.2847

Cited by 35 publications

(51 citation statements)

References 35 publications

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“…Since the MAGIC guidelines were published in 2015,2 several papers have examined the appropriateness of PICC use based on a large multicentre study of hospitals participating in the Michigan Hospital Medicine Safety Consortium 6–8 23. The indications for PICC placement, patterns of use and PICC-associated complications varied across hospitals in Michigan (eg, PICC complications varied from 4% to 36%) 6.…”

Section: Discussionmentioning

confidence: 99%

“…The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) describes appropriate and inappropriate criteria for PICC use based on an international expert panel 2. 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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…The Michigan Appropriateness Guide for Intravenous Catheters helps practitioners assess vascular access options and choose the best options for their patients . Hospitalist services are studying and refining the application of these guidelines …”

Section: Discussionmentioning

confidence: 99%

Don't Pick the PICC

2019

AORN Journal

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“…There is likely a place for anti-thrombogenic PICCs in many patients, however healthcare institutions may not find an impetus to move towards these devices if they remain unaware of the high rate of complications associated with PICCs they currently use. 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].…”

Section: How the Technology Fits Intomentioning

confidence: 99%

Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety

Ullman

Bulmer

Dargaville

et al. 2018

Expert Review of Medical Devices

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Introduction: Thrombotic complications associated with peripherally inserted central catheters (PICCs) are common, as most synthetic materials when placed in the presence of serum often result in platelet activation, fibrin deposition, thrombotic occlusion and potentially embolization. A current innovation focus has been the development of antithrombogenic catheter materials, including hydrophilic and hydrophobic surfaces. These are being incorporated into PICCs in an attempt to prevent the normal thrombotic cascade leading to patient harm. Areas covered: This review focuses on the laboratory efficacy and clinical effectiveness of anti-thrombogenic PICCs to prevent PICC-associated thrombosis, as well as their efficiency and safety. This synthesis was informed by a systematic identification of published and unpublished laboratory and clinical studies evaluating these technologies. Expert commentary: A range of PICCs have been developed with anti-thrombogenic claims, using varying technologies. However, to date there is no peer-reviewed laboratory research describing the individual PICCs effectiveness. Despite promising early clinical trials, adequately powered trials to establish efficacy, effectiveness, efficiency and safety of all of the individual products, have not yet been undertaken.

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Patterns and Predictors of Short‐Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study

Abstract: Short-term use of PICCs is common and associated with patient, provider, and device factors. As PICC placement, even for brief periods, is associated with complications, efforts targeted at factors underlying such use appear necessary.

Cited by 35 publications

References 35 publications

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

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

Don't Pick the PICC

Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety

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