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September 15, 2015

Michigan Appropriateness Guide for PICCs Published

September 15, 2015—In Annals of Internal Medicine, Vineet Chopra, MD, et al published the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC), based on results from a multispecialty panel using the RAND/UCLA appropriateness method (2015;163:S1–S40).

The background of the MAGIC document is that use of peripherally inserted central catheters (PICCs) has substantially grown in recent years, which 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, advised the authors.

As summarized in Annals of Internal Medicine, the international MAGIC panel was convened to apply the RAND/UCLA Appropriateness Method in order to develop criteria for the use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to the patient population (eg, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs vesicants), and duration of use (≤ 5 days, 6–14 days, 15–30 days, or ≥ 31 days). Within each scenario, the appropriateness of PICC use was compared with that of other venous access devices.

The panel reviewed 665 scenarios, rating 253 (38%) 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 days or fewer. 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 MAGIC 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 patient safety, advised the panel in Annals of Internal Medicine.

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