title: The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method.
abstract: Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use 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. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated 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 or fewer days. 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 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 the safety of medical patients.
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: Scott C
authors.initials: SC
authors.lastname: Woller
authors.forename: Naomi P
authors.initials: NP
authors.lastname: O'Grady
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: Nancy
authors.initials: N
authors.lastname: Moureau
authors.forename: Stephen
authors.initials: S
authors.lastname: Wiseman
authors.forename: Mauro
authors.initials: M
authors.lastname: Pittiruti
authors.forename: Elie A
authors.initials: EA
authors.lastname: Akl
authors.forename: Agnes Y
authors.initials: AY
authors.lastname: Lee
authors.forename: Anthony
authors.initials: A
authors.lastname: Courey
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Swaminathan
authors.forename: Jack
authors.initials: J
authors.lastname: LeDonne
authors.forename: Carol
authors.initials: C
authors.lastname: Becker
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000628:therapy; D020878:Device Removal; D006760:Hospitalization; D006801:Humans; D008824:Michigan; D009369:Neoplasms / Q000628:therapy; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D019564:Unnecessary Procedures