2022
Understanding consumer preference for vascular access safety and quality measurement: an international survey
Aust Health Rev
Objectives: The aim of this study was to examine patient perceptions regarding vascular access quality measurement. Methods: A web-based, cross-sectional survey was performed using a convenience sample of healthcare consumers with vascular access experience, recruited from September 2019 to June 2020. Survey respondents were asked to rate the perceived importance of 50 vascular access...
Objectives: The aim of this study was to examine patient perceptions regarding vascular access quality measurement. Methods: A web-based, cross-sectional survey was performed using a convenience sample of healthcare consumers with vascular access experience, recruited from September 2019 to June 2020. Survey respondents were asked to rate the perceived importance of 50 vascular access...
Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients With Short-term Indications: A Multicenter Study
JAMA Intern Med
Question: In patients with difficult intravenous access or those who require short-term intravenous antibiotics, are midline catheters safer than peripherally inserted central catheters (PICCs)? Findings: In this cohort study of 10 863 patients across multiple hospitals who received 5758 PICCs and 5105 midlines for difficult access or short-term antibiotic therapy, midlines were associated with fewer...
Question: In patients with difficult intravenous access or those who require short-term intravenous antibiotics, are midline catheters safer than peripherally inserted central catheters (PICCs)? Findings: In this cohort study of 10 863 patients across multiple hospitals who received 5758 PICCs and 5105 midlines for difficult access or short-term antibiotic therapy, midlines were associated with fewer...
Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals
BMJ Qual Saf
Central venous access catheters are often used for patients requiring repeated infusions, blood sampling, invasive monitoring or where peripheral access is difficult. For intravenous access of up to 2 weeks in duration, a midline catheter is usually satisfactory, but for longer-term use, peripherally inserted central catheters (PICCs) are increasingly used, including in clinical areas outside of critical care.
Central venous access catheters are often used for patients requiring repeated infusions, blood sampling, invasive monitoring or where peripheral access is difficult. For intravenous access of up to 2 weeks in duration, a midline catheter is usually satisfactory, but for longer-term use, peripherally inserted central catheters (PICCs) are increasingly used, including in clinical areas outside of critical care.
2021
Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters
Int J Nurs Stud
Background: Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. Objectives:
Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes...
Background: Peripheral intravenous catheters are an essential medical device which are prone to complications and failure. Objectives:
Identify patient, provider and device risk factors associated with all-cause peripheral intravenous catheter failure as well as individual complications: phlebitis, infiltration/occlusion, and dislodgement to improve patient outcomes...
International recommendations for a vascular access minimum dataset: a Delphi consensus-building study
BMJ Qual Saf
Background: Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. Methods: A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel)...
Background: Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. Methods: A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel)...
Comment on: Use of peripherally inserted central catheters (PICCs) in ICU patients
J Crit Care
We thank our colleagues from Brussels for their thoughtful comments on vascular access in the ICU. We are in full agreement regarding the risks associated with PICC use in hospitalized patients. Previous studies have shown a two-fold increase in the risk of venous thromboembolism with PICCs compared to traditional central venous catheters (CVCs). Additionally, data suggests high rates of...
We thank our colleagues from Brussels for their thoughtful comments on vascular access in the ICU. We are in full agreement regarding the risks associated with PICC use in hospitalized patients. Previous studies have shown a two-fold increase in the risk of venous thromboembolism with PICCs compared to traditional central venous catheters (CVCs). Additionally, data suggests high rates of...
Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study
BMJ Qual Saf
Background: Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models. Methods: We used a descriptive qualitative methodology and a naturalist philosophy, with site...
Background: Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models. Methods: We used a descriptive qualitative methodology and a naturalist philosophy, with site...
Appropriate vascular access for patients with cancer
Lancet
Questions as to how best to meet vascular access needs and safety requirements when caring for patients with cancer occur daily in clinical practice, yet evidence for which methods are optimal is poor. In cancer, use of vascular devices such as peripherally inserted central catheters (PICCs), Hickman-type tunnelled catheters (eg, Hickman), or totally implanted ports (PORTs) is common. Collectively...
Questions as to how best to meet vascular access needs and safety requirements when caring for patients with cancer occur daily in clinical practice, yet evidence for which methods are optimal is poor. In cancer, use of vascular devices such as peripherally inserted central catheters (PICCs), Hickman-type tunnelled catheters (eg, Hickman), or totally implanted ports (PORTs) is common. Collectively...
To PICC or not to PICC? A cross-sectional survey of vascular access practices in the ICU
J Crit Care
Purpose: Vascular access patterns in the intensive care unit (ICU) have shifted from non-tunneled central venous catheters (CVCs) towards peripherally inserted central catheters (PICCs). We evaluated perceptions of critical care practitioners regarding these devices and variation in evidence-based practice. Materials: A 35-question survey on ICU vascular access was deployed in 13 Michigan...
Purpose: Vascular access patterns in the intensive care unit (ICU) have shifted from non-tunneled central venous catheters (CVCs) towards peripherally inserted central catheters (PICCs). We evaluated perceptions of critical care practitioners regarding these devices and variation in evidence-based practice. Materials: A 35-question survey on ICU vascular access was deployed in 13 Michigan...
Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomised controlled trial protocol
BMJ Open
Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications.
Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications.
An Implementation Framework for the Clinically Indicated Removal Policy for Peripheral Intravenous Catheters
J Nurs Care Qual
Background: Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication. Problem: Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding...
Background: Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication. Problem: Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding...
Peripherally Inserted Central Catheter Thrombosis After Placement via Electrocardiography vs Traditional Methods
Am J Med
Background: Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. Methods: Prospectively collected data from patients that received peripherally...
Background: Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis. Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown. Methods: Prospectively collected data from patients that received peripherally...
Needleless connector decontamination for prevention of central venous access device infection: A pilot randomized controlled trial
Am J Infect Control
Pilot randomized controlled trial (180 patients) of needleless connector decontamination. Central line-associated bloodstream infection occurred in 2% (1/61) of 70% isopropyl alcohol (IPA) wipe, 2% (1/59) of 70% IPA cap, and zero (0/58) infections in 2% chlorhexidine gluconate in 70% IPA wipe patients. Larger definitive trials are feasible and...
Pilot randomized controlled trial (180 patients) of needleless connector decontamination. Central line-associated bloodstream infection occurred in 2% (1/61) of 70% isopropyl alcohol (IPA) wipe, 2% (1/59) of 70% IPA cap, and zero (0/58) infections in 2% chlorhexidine gluconate in 70% IPA wipe patients. Larger definitive trials are feasible and...
How common are indwelling devices in hospitalized adults? A contemporary point prevalence study in a tertiary care hospital
Am J Infect Control
Background: Healthcare associated infections are associated with indwelling devices. Yet, data regarding prevalence of indwelling devices in noncritically ill hospitalized patients remains scant. Methods: Adult, noncritically ill patients on general care, telemetry, and surgical floors at our quaternary care hospital were surveyed on 2 separate days. Data...
Background: Healthcare associated infections are associated with indwelling devices. Yet, data regarding prevalence of indwelling devices in noncritically ill hospitalized patients remains scant. Methods: Adult, noncritically ill patients on general care, telemetry, and surgical floors at our quaternary care hospital were surveyed on 2 separate days. Data...
2020
An Implementation Framework for the Clinically Indicated Removal Policy for Peripheral Venous Catheters
J Nurs Care Qual
Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication. Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding...
Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication. Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding...
Peripherally Inserted Central Catheter Thrombosis Following placement via electrocardiography vs. traditional methods: an analysis of 42,687 patients
Am J Med
Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis . Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown.
Peripherally inserted central catheter tip placement at the cavoatrial junction is associated with reduced catheter-related deep vein thrombosis . Electrocardiographic tip confirmation purportedly improves accuracy of tip placement, but whether this approach can reduce deep vein thrombosis is unknown.
The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC
Pediatrics
Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion...
Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion...
Developing Appropriateness Criteria for Pediatric Vascular Access
Pediatrics
To describe the methodology undertaken to provide guidance on the appropriateness, as well as inappropriateness, of vascular access device selection, characteristics, and insertion technique for pediatric patients. The RAND Corporation–University of California, Los Angeles Appropriateness Method was used. After definition of key terms and scope, a systematic review of...
To describe the methodology undertaken to provide guidance on the appropriateness, as well as inappropriateness, of vascular access device selection, characteristics, and insertion technique for pediatric patients. The RAND Corporation–University of California, Los Angeles Appropriateness Method was used. After definition of key terms and scope, a systematic review of...
Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review
Pediatrics
To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. Clinical practice guidelines, systematic reviews, cohort designs, ...
To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. Clinical practice guidelines, systematic reviews, cohort designs, ...
Developing Pediatric Appropriateness Criteria for Intravenous Catheters
Pediatrics
This editorial lays out the rationale behind the development of miniMAGIC, the new pediatric vascular access appropriateness criteria developed using the same methodology as the highly successful MAGIC algorithm.
This editorial lays out the rationale behind the development of miniMAGIC, the new pediatric vascular access appropriateness criteria developed using the same methodology as the highly successful MAGIC algorithm.
Making MAGIC: how to improve the use of peripherally inserted central catheters
BMJ Qual Saf
This editorial introduces the first validation results of MAGIC based on results in Michigan hospitals, showing a strong correlation between implementation of these guidelines and reduced inappropriate PICC usage.
This editorial introduces the first validation results of MAGIC based on results in Michigan hospitals, showing a strong correlation between implementation of these guidelines and reduced inappropriate PICC usage.
Use of and patient-reported complications related to midline catheters and peripherally inserted central catheters
Infect Control Hosp Epidemiol
We conducted a prospective observational study of indications for use and patient experiences with midline catheters (n = 50) compared to peripherally inserted central catheters (n = 63). The primary indication for patients with midline catheters was difficult venous access. Patients with midline catheters reported fewer complications than patients with peripherally inserted central catheters.
We conducted a prospective observational study of indications for use and patient experiences with midline catheters (n = 50) compared to peripherally inserted central catheters (n = 63). The primary indication for patients with midline catheters was difficult venous access. Patients with midline catheters reported fewer complications than patients with peripherally inserted central catheters.
The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation
BMJ Open
Objective: To describe the clinimetric validation of the I-DECIDED tool for peripheral intravenous catheter assessment and decision-making. Design and setting: I-DECIDED is an eight-step tool derived from international vascular access guidelines into a structured mnemonic for device assessment and decision-making. The clinimetric evaluation process was conducted in three distinct phases.
Objective: To describe the clinimetric validation of the I-DECIDED tool for peripheral intravenous catheter assessment and decision-making. Design and setting: I-DECIDED is an eight-step tool derived from international vascular access guidelines into a structured mnemonic for device assessment and decision-making. The clinimetric evaluation process was conducted in three distinct phases.
2019
Long Peripheral Catheters: A Retrospective Review of Major Complications
J Hosp Med
The risk of infectious and noninfectious complications associated with long peripheral catheters (LPCs) is unknown. In this retrospective study of 539 catheters, we found LPCs were often placed for the indications of difficult access and long-term antibiotics. Rates of deep vein thrombosis (1.7%) and catheter-related infection (0.6%) were low. LPCs may represent a novel and safe option for short-term venous access.
The risk of infectious and noninfectious complications associated with long peripheral catheters (LPCs) is unknown. In this retrospective study of 539 catheters, we found LPCs were often placed for the indications of difficult access and long-term antibiotics. Rates of deep vein thrombosis (1.7%) and catheter-related infection (0.6%) were low. LPCs may represent a novel and safe option for short-term venous access.
Use of Designated Nurse PICC Teams and CLABSI Prevention Practices Among U.S. Hospitals
J Patient Saf
The use of peripherally inserted central catheters (PICCs) has increased substantially within hospitals during the past several years. Yet, the prevalence and practices of designated nurse PICC teams (i.e., specially trained nurses who are responsible for PICC insertions at a hospital) are unknown. We, therefore, identified the prevalence of and factors associated with having a designated nurse PICC team among U.S. acute care hospitals.
The use of peripherally inserted central catheters (PICCs) has increased substantially within hospitals during the past several years. Yet, the prevalence and practices of designated nurse PICC teams (i.e., specially trained nurses who are responsible for PICC insertions at a hospital) are unknown. We, therefore, identified the prevalence of and factors associated with having a designated nurse PICC team among U.S. acute care hospitals.
Use of Peripherally Inserted Central Catheters in Patients With Advanced Chronic Kidney Disease: A Prospective Cohort Study
Ann Intern Med
Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD). To describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD.
Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD). To describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD.
Quantitative Results of a National Intervention to Prevent Central Line–Associated Bloodstream Infection: A Pre-Post Observational Study
Ann Intern Med
Background: Central line–associated bloodstream infection (CLABSI) remains prevalent in hospitals in the United States. Objective:
To evaluate the impact of a multimodal intervention in hospitals with elevated rates of health care–associated infection. Design:
Pre–post observational evaluation of a prospective, national, clustered, nonrandomized initiative of 3 cohorts of hospitals.
Background: Central line–associated bloodstream infection (CLABSI) remains prevalent in hospitals in the United States. Objective:
To evaluate the impact of a multimodal intervention in hospitals with elevated rates of health care–associated infection. Design:
Pre–post observational evaluation of a prospective, national, clustered, nonrandomized initiative of 3 cohorts of hospitals.
What do patients say about their experience with urinary catheters and peripherally inserted central catheters?
Am J Infect Control
Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices.
Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices.
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study
BMJ Qual Saf
While midline vascular catheters are gaining popularity in clinical practice, patterns of use and outcomes related to these devices are not well known. Trained abstractors collected data from medical records of hospitalised patients who received midline catheters in 12 hospitals. Device characteristics, patterns of use and outcomes were assessed at device removal or at 30 days. Rates of major (upper-extremity deep vein thrombosis [DVT], bloodstream infection [BSI] and catheter occlusion) and minor complications were assessed. χ2 tests were used to examine differences in rates of complication by number of lumens, reasons for catheter removal l, and hospital-level differences in rates of midline use.
While midline vascular catheters are gaining popularity in clinical practice, patterns of use and outcomes related to these devices are not well known. Trained abstractors collected data from medical records of hospitalised patients who received midline catheters in 12 hospitals. Device characteristics, patterns of use and outcomes were assessed at device removal or at 30 days. Rates of major (upper-extremity deep vein thrombosis [DVT], bloodstream infection [BSI] and catheter occlusion) and minor complications were assessed. χ2 tests were used to examine differences in rates of complication by number of lumens, reasons for catheter removal l, and hospital-level differences in rates of midline use.
What US hospitals are currently doing to prevent common device-associated infections: results from a national survey
BMJ Qual Saf
Despite focused initiatives to reduce device-associated infection among hospitalised patients, the practices US hospitals are currently using are unknown. We thus used a national survey to ascertain the use of several established and novel practices to prevent device-associated infections.
Despite focused initiatives to reduce device-associated infection among hospitalised patients, the practices US hospitals are currently using are unknown. We thus used a national survey to ascertain the use of several established and novel practices to prevent device-associated infections.
The Association of Antibiotic Stewardship With Fluoroquinolone Prescribing in Michigan Hospitals: A Mutli-hospital Cohort Study
Clin Infect Dis
Fluoroquinolones increase the risk of Clostridioides difficile infection and antibiotic resistance. Hospitals often use pre-prescription approval or prospective audit and feedback to target fluoroquinolone prescribing. Whether these strategies impact aggregate fluoroquinolone use is unknown.
Fluoroquinolones increase the risk of Clostridioides difficile infection and antibiotic resistance. Hospitals often use pre-prescription approval or prospective audit and feedback to target fluoroquinolone prescribing. Whether these strategies impact aggregate fluoroquinolone use is unknown.
Antithrombogenic Peripherally Inserted Central Catheters: Overview of Safety and Efficacy
Expert Rev Medical Devices
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. This review focuses on the laboratory efficacy and clinical effectiveness of antithrombogenic PICCs to prevent PICC-associated thrombosis, as well as their efficiency and safety.
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. This review focuses on the laboratory efficacy and clinical effectiveness of antithrombogenic PICCs to prevent PICC-associated thrombosis, as well as their efficiency and safety.
Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study
BMJ Qual Saf
Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications from a patient perspective remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation. Access the full article free of charge here.
Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications from a patient perspective remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation. Access the full article free of charge here.
Choosing the Right Central Venous Catheter for Parenteral Nutrition
Am J Gastroentrol
The practice of safe and effective enteral nutrition (EN) and parenteral nutrition (PN) support is an important aspect in the abilities of a clinical gastroenterologist. Unfortunately, formal education programs for nutrition training in the course of a gastroenterology fellowship are often lacking.
The practice of safe and effective enteral nutrition (EN) and parenteral nutrition (PN) support is an important aspect in the abilities of a clinical gastroenterologist. Unfortunately, formal education programs for nutrition training in the course of a gastroenterology fellowship are often lacking.
Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety
Expert Rev Med Devices
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.
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.
2018
Comparative thrombosis risk of vascular access devices among critically ill medical patients
Thromb Res
Central venous catheters (CVC) and peripherally inserted central catheters (PICCs) are central vascular access devices (CVADs) that facilitate administration of medications among critically ill patients. Both are associated with risk of venous thromboembolism (VTE). The relative risk of VTE between these catheter types is not well defined. This study compared rates of VTE in patients receiving PICCs, CVCs, or both in a critically ill population.
Central venous catheters (CVC) and peripherally inserted central catheters (PICCs) are central vascular access devices (CVADs) that facilitate administration of medications among critically ill patients. Both are associated with risk of venous thromboembolism (VTE). The relative risk of VTE between these catheter types is not well defined. This study compared rates of VTE in patients receiving PICCs, CVCs, or both in a critically ill population.
Less Lumens-Less Risk: A Pilot Intervention to Increase the Use of Single-Lumen Peripherally Inserted Central Catheters
J Hosp Med
To reduce risk of complications, existing guidelines recommend use of peripherally inserted central catheters (PICCs) with the minimal number of lumens. This recommendation, however, is difficult to implement in practice. We conducted a pilot study to increase the use of single-lumen PICCs in hospitalized patients.
To reduce risk of complications, existing guidelines recommend use of peripherally inserted central catheters (PICCs) with the minimal number of lumens. This recommendation, however, is difficult to implement in practice. We conducted a pilot study to increase the use of single-lumen PICCs in hospitalized patients.
Choosing the Right Central Venous Catheter for Parenteral Nutrition
Am J Gastroenterol
The practice of safe and effective enteral nutrition (EN) and parenteral nutrition (PN) support is an important aspect in the abilities of a clinical gastroenterologist. Unfortunately, formal education programs for nutrition training in the course of a gastroenterology fellowship are often lacking.
The practice of safe and effective enteral nutrition (EN) and parenteral nutrition (PN) support is an important aspect in the abilities of a clinical gastroenterologist. Unfortunately, formal education programs for nutrition training in the course of a gastroenterology fellowship are often lacking.
Use of Venous Thromboembolism Prophylaxis in Hospitalized Patients
JAMA Intern Med
National guidelines recommend objective risk stratification for venous thromboembolism (VTE) in hospitalized medical patients. ... Using data from the HMS we sought to determine whether patients in this cohort were receiving appropriate VTE prophylaxis.
National guidelines recommend objective risk stratification for venous thromboembolism (VTE) in hospitalized medical patients. ... Using data from the HMS we sought to determine whether patients in this cohort were receiving appropriate VTE prophylaxis.
Peripherally Inserted Central Catheters in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals
Critical Care Med
This study examined prevalence and patterns of PICC use in medical ICUs and general medicine wards. The paper sought to describe differences indications, duration of use, complications and outcomes among patients that received PICCs in these settings.
This study examined prevalence and patterns of PICC use in medical ICUs and general medicine wards. The paper sought to describe differences indications, duration of use, complications and outcomes among patients that received PICCs in these settings.
A State of the Art Review on Optimal Practices to Prevent, Recognize, and Manage Complications Associated with Intravascular Devices in the Critically Ill
Intensive Care Med
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU.
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU.
Patterns and Predictors of Short-Term Peripherally Inserted Central Cather Use: A Multicenter Prospective Cohort Study
J Hosp Med
The guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated duration of use is =5 days. However, short-term PICC use is common in hospitals. We sought to identify patient, provider, and device characteristics and...
The guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated duration of use is =5 days. However, short-term PICC use is common in hospitals. We sought to identify patient, provider, and device characteristics and...
Risk of Venous Thromboembolism Following Peripherally Inserted Central Catheter Exchange: an Analysis of 23,000 Hospitalized Patients
Am J Med
Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known.
Catheter exchange over a guidewire is frequently performed for malfunctioning peripherally inserted central catheters (PICCs). Whether such exchanges are associated with venous thromboembolism is not known.
2017
Does Certification in Vascular Access Matter? An Analysis of the PICC1 Survey
Am J Nurs
Although certification by an accredited agency is often a practice prerequisite in health care, it is not required of vascular access specialists who insert peripherally inserted central catheters (PICCs). Whether certification is associated with differences in...
Although certification by an accredited agency is often a practice prerequisite in health care, it is not required of vascular access specialists who insert peripherally inserted central catheters (PICCs). Whether certification is associated with differences in...
Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria
BMJ Qual Saf
Although important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing. Objective: To test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use....
Although important in clinical care, reports of inappropriate peripherally inserted central catheter (PICC) use are growing. Objective: To test whether implementation of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) can improve PICC use....
A Model to Predict Central-Line-Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score
Infect Control Hosp Epidemiol
Peripherally inserted central catheters (PICCs) are associated with central-line–associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed.
Peripherally inserted central catheters (PICCs) are associated with central-line–associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed.
Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs
J Hosp Med
Central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, Some intensive care units (ICUs) continue to have elevated infection rates.
Central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, Some intensive care units (ICUs) continue to have elevated infection rates.
The Michigan Risk Score to Predict Peripherally Inserted Central Catheter-Associated Thrombosis
J Thromb Haemost
Peripherally inserted central catheters (PICCs) are associated with upper extremity deep vein thrombosis (DVT). We developed a score to predict risk of PICC-related thrombosis.
Peripherally inserted central catheters (PICCs) are associated with upper extremity deep vein thrombosis (DVT). We developed a score to predict risk of PICC-related thrombosis.
A contemporary assessment of mechanical complication rates and trainee perceptions of central venous catheter insertion
J Hosp Med
Limited data exist regarding rates of mechanical complications of ultrasound-guided, nontunneled central venous catheters (CVC). Similarly, trainee perceptions surrounding CVC complications are largely unknown.
Limited data exist regarding rates of mechanical complications of ultrasound-guided, nontunneled central venous catheters (CVC). Similarly, trainee perceptions surrounding CVC complications are largely unknown.
Peripherally InSerted CEntral catheter dressing and securement in patients with cancer: the PISCES trial. Protocol for a 2x2 factorial, superiority randomised controlled trial.
BMJ
Around 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective PICC dressing and securement may prevent...
Around 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective PICC dressing and securement may prevent...
Patterns and Predictors of Peripherally Inserted Central Catheter Occlusion: the 3PO Study
J Vasc Interven Radiol
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)–related occlusion. Data from a multihospital study were used to examine factors associated with PICC occlusion.
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)–related occlusion. Data from a multihospital study were used to examine factors associated with PICC occlusion.
Neonatal Peripherally Inserted Central Catheter Practices and Providers: Results from the Neonatal PICC1 Survey
Adv Neonatal Care
Neonatal intensive care units (NICUs) commonly utilize peripherally inserted central catheters (PICCs) to provide nutrition and long-term medications to premature and full-term infants. However, little is known about PICC practices in these settings. The purpose of this study is to assess PICC practices, policies, and providers in NICUs.
Neonatal intensive care units (NICUs) commonly utilize peripherally inserted central catheters (PICCs) to provide nutrition and long-term medications to premature and full-term infants. However, little is known about PICC practices in these settings. The purpose of this study is to assess PICC practices, policies, and providers in NICUs.
Variation in use of technology among vascular access specialists: an analysis of the PICC1 survey
J Vascular Access
While the use of technologies such as ultrasound and electrocardiographic (ECG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the clinicians who use these tools or their work settings.
While the use of technologies such as ultrasound and electrocardiographic (ECG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the clinicians who use these tools or their work settings.
The relationship between perceived role and appropriate use of peripherally inserted central catheters: A survey of vascular access nurses in the United States
Int J Nurs Studies
The presence and proliferation of vascular access nursing in hospital settings has been identified as a potential contributor to growing demand, and possible overuse, of peripherally inserted central catheters (PICCs). We examined vascular access nurses' perceived role related to use of PICCs and the association with appropriateness of PICC use in hospitals
The presence and proliferation of vascular access nursing in hospital settings has been identified as a potential contributor to growing demand, and possible overuse, of peripherally inserted central catheters (PICCs). We examined vascular access nurses' perceived role related to use of PICCs and the association with appropriateness of PICC use in hospitals
Vascular access training, experience, and practice in the United States: Results from the national PICC1 survey
J Infus Nurs
Vascular access specialists are increasingly responsible for insertion and care of peripherally inserted central catheters in the United States. Despite proliferation of the specialty, little is known about the training, practice patterns, and experiences of these clinicians.
Vascular access specialists are increasingly responsible for insertion and care of peripherally inserted central catheters in the United States. Despite proliferation of the specialty, little is known about the training, practice patterns, and experiences of these clinicians.
2016
What’s new in skin antisepsis for short-term intravascular catheters: new data to address old problems?
Intensive Care Med
Although the incidence of short-term vascular catheter-related infections (CRI) is decreasing, CRI remains a leading cause of healthcare-associated infections (HAI) in intensive care units (ICUs) and the most preventable HAI. During the first week of catheterization, colonization of the catheter from skin pathogens and subsequent infection is the main source for CRI; hence, optimal skin preparation prior to catheter placement and during catheter use is paramount for prevention.
Although the incidence of short-term vascular catheter-related infections (CRI) is decreasing, CRI remains a leading cause of healthcare-associated infections (HAI) in intensive care units (ICUs) and the most preventable HAI. During the first week of catheterization, colonization of the catheter from skin pathogens and subsequent infection is the main source for CRI; hence, optimal skin preparation prior to catheter placement and during catheter use is paramount for prevention.
Challenges for Nurses Caring for Patients with Peripherally Inserted Central Catheters in Skilled Nursing Facilities
J Am Geriatr Soc
To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs.
To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs.
Association between delivery methods for red blood cell transfusion and risk of venous thromboembolism: a longitudinal study
Lancet Hematology
Blood is prothrombotic. So too are PICCs. In this analysis, we examined whether the device used for delivery of blood (peripheral IV, central venous catheter, single vs. multi-lumen PICC) influences risk of subsequent thrombosis. In 10,604 patients, 482 (5%) developed VTE. Risk of VTE was greater for patients whose transfusion was given through a multi-lumen PICC than for those who did not receive a transfusion (hazard ratio [HR] 1·96, 95% CI 1·47–2·61; p<0·0001). Compared with delivery through a PIV, VTE risk was not elevated if transfusions were delivered through a single-lumen PICC (HR 0·98, 95% CI 0·44–2·14; p=0·95) or central venous catheter (1·50, 0·77–2·91; p=0·23). For every red blood cell unit transfused through a PICC, a significantly increased risk of venous thromboembolism (adjusted HR 1·24, 95% CI 1·01–1·52; p=0·037) was noted. Risk of VTE with multi-lumen PICCs was not associated with gauge, but with lumens.
Blood is prothrombotic. So too are PICCs. In this analysis, we examined whether the device used for delivery of blood (peripheral IV, central venous catheter, single vs. multi-lumen PICC) influences risk of subsequent thrombosis. In 10,604 patients, 482 (5%) developed VTE. Risk of VTE was greater for patients whose transfusion was given through a multi-lumen PICC than for those who did not receive a transfusion (hazard ratio [HR] 1·96, 95% CI 1·47–2·61; p<0·0001). Compared with delivery through a PIV, VTE risk was not elevated if transfusions were delivered through a single-lumen PICC (HR 0·98, 95% CI 0·44–2·14; p=0·95) or central venous catheter (1·50, 0·77–2·91; p=0·23). For every red blood cell unit transfused through a PICC, a significantly increased risk of venous thromboembolism (adjusted HR 1·24, 95% CI 1·01–1·52; p=0·037) was noted. Risk of VTE with multi-lumen PICCs was not associated with gauge, but with lumens.
Using "MAGIC" To Facilitate Appropriate PICC Use: Implementation of a PICC Appropriateness Tool
J Hospital Med
This abstract presentation is the first to describe how MAGIC can be used to improve the appropriateness of PICC use. This hospital reported a substantial decrease in rates of inappropriate PICC use following implementation. Use of single lumen devices increased substantially while rates of PICC Use <5d dropped.
This is the power of MAGIC.
This abstract presentation is the first to describe how MAGIC can be used to improve the appropriateness of PICC use. This hospital reported a substantial decrease in rates of inappropriate PICC use following implementation. Use of single lumen devices increased substantially while rates of PICC Use <5d dropped.
This is the power of MAGIC.
Peripherally Inserted Central Catheters (PICCs) in CKD: PICC’ing the Best Access for Kidney Disease Patients
Am J Kidney Dis
This editorial accompanies our manuscript examining the association between PICC use and upper and lower extremity thrombosis in hospitalized medical patients.
This editorial accompanies our manuscript examining the association between PICC use and upper and lower extremity thrombosis in hospitalized medical patients.
Peripherally Inserted Central Catheters-Improving Appropriateness With a Dedicated and Rigorous Team- Reply.
JAMA Intern Med
Reimagining the role of vascular access nurses in the United States - our reply to clinicians in Italy and call for a change in policy and practice.
Reimagining the role of vascular access nurses in the United States - our reply to clinicians in Italy and call for a change in policy and practice.
Use of decision aids for shared decision making in venous thromboembolism: A systematic review
Thromb Res
Optimal care of patients with venous thromboembolism requires the input of patient preferences into clinical decision-making. However, the availability and impact of decision aids to facilitate shared decision making in care of venous thromboembolism is not well known.
Optimal care of patients with venous thromboembolism requires the input of patient preferences into clinical decision-making. However, the availability and impact of decision aids to facilitate shared decision making in care of venous thromboembolism is not well known.
Are Antimicrobial Peripherally Inserted Central Catheters Associated with Reduction in Central Line-Associated Bloodstream Infection? A Systematic Review and Meta-Analysis
Am J Infect Control
This systematic review and meta-analysis of seven studies (including 1 randomized trial) reports the effect of antimicrobial PICCs on CLABSI. The study finds significant reduction of CHG and minocycline-coated catheters on CLABSI, especially in high-risk populations.
This systematic review and meta-analysis of seven studies (including 1 randomized trial) reports the effect of antimicrobial PICCs on CLABSI. The study finds significant reduction of CHG and minocycline-coated catheters on CLABSI, especially in high-risk populations.
Making the MAGIC Guiding Vascular Access Selection for Intensive Care - a Summary of Michigan Appropriateness Guide for Intravenous Catheters (MAGIC)
ICU Management and Practice
Determining appropriateness for vascular access devices limits the risk of complications in critically ill patients. Michigan Appropriateness Guide to Intravenous Catheters (MAGIC) establishes evidence-based indications as summarised in this paper.
Determining appropriateness for vascular access devices limits the risk of complications in critically ill patients. Michigan Appropriateness Guide to Intravenous Catheters (MAGIC) establishes evidence-based indications as summarised in this paper.
Indications for peripheral, midline and central catheters: summary of the MAGIC Recommendations
Br J Nursing
Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access, those requiring multiple attempts, those who are obese, or have diabetes or other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing.
Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access, those requiring multiple attempts, those who are obese, or have diabetes or other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing.
Variation in Prevalence and Patterns of PICC Use in Adults Hospitalized with Pneumonia
J Hospital Med
This large secondary data analysis examines patterns and prevalence of PICC use in pneumonia using PREMIER data from 545,150 patients. The analysis finds PICC use is common among younger, but sicker patients. Critical care physicians and geriatricians were most likely to order PICC insertion. Rates of PICC use in pneumonia vary widely across US hospitals, from 0.3 to 41.7%.
This large secondary data analysis examines patterns and prevalence of PICC use in pneumonia using PREMIER data from 545,150 patients. The analysis finds PICC use is common among younger, but sicker patients. Critical care physicians and geriatricians were most likely to order PICC insertion. Rates of PICC use in pneumonia vary widely across US hospitals, from 0.3 to 41.7%.
Limiting the Number of PICC Lumens to Improve Outcomes and Reduce Cost: A Simulation Study
Infection Control Hosp Epid
PICC lumens are known to be associated with infectious and thrombotic risks. However, savings associated with policies that restrict use of multi-lumen PICCs for specific indications are not known. This cost-analysis sheds new light on this question by examining costs related to device acquisition, care/ maintenance and complications between single and multi-lumen PICCs.
PICC lumens are known to be associated with infectious and thrombotic risks. However, savings associated with policies that restrict use of multi-lumen PICCs for specific indications are not known. This cost-analysis sheds new light on this question by examining costs related to device acquisition, care/ maintenance and complications between single and multi-lumen PICCs.
Revisiting The PanCulture
BMJ Qual and Safety
Many of us draw cultures off PICCs and CVCs, only to realize they are contaminated or clinically irrelevant. Yet decisions such as removing the catheter are often made based on these results. This brief essay describes the problems with the "panculture" approach and provides specific guidance on when microbiological evaluations should be performed.
Many of us draw cultures off PICCs and CVCs, only to realize they are contaminated or clinically irrelevant. Yet decisions such as removing the catheter are often made based on these results. This brief essay describes the problems with the "panculture" approach and provides specific guidance on when microbiological evaluations should be performed.
Variation in Patterns of Peripherally Inserted Central Catheter Use and Outcomes in Michigan Hospitals
JAMA Internal Medicine
This large prospective cohort study reports indications for use, dwell times and outcomes from 3,378 PICCs placed in 3,201 patients in 10 Michigan hospitals. Significant variation in rationale for PICC placement, patterns of use and risk of various adverse events are reported.
This large prospective cohort study reports indications for use, dwell times and outcomes from 3,378 PICCs placed in 3,201 patients in 10 Michigan hospitals. Significant variation in rationale for PICC placement, patterns of use and risk of various adverse events are reported.
Whats New in Catheter-Related Infection: Skin Cleansing and Skin Antisepsis
Intensive Care Medicine
This review (written with Prof. Olivier Mimoz in France) describes the state of the art of skin cleaning to prevent catheter infections. We review results of the CLEAN trial which compared 2% CHG/70% alcohol to 5% povidone iodine in ethanol and discuss implications for practice.
This review (written with Prof. Olivier Mimoz in France) describes the state of the art of skin cleaning to prevent catheter infections. We review results of the CLEAN trial which compared 2% CHG/70% alcohol to 5% povidone iodine in ethanol and discuss implications for practice.
Vascular Nursing Practice, Experience, Knowledge and Beliefs: Results from the Michigan PICC1 Survey
J Hosp Med
This survey based study of 140 PICC-trained vascular nurses in 47 Michigan hospitals provides unique insights in the speciality of vascular access nursing, including elements such as practice characteristics, hospital resources, relations with leadership, and certification status.
This survey based study of 140 PICC-trained vascular nurses in 47 Michigan hospitals provides unique insights in the speciality of vascular access nursing, including elements such as practice characteristics, hospital resources, relations with leadership, and certification status.
2015
The Association Between PICC Use and Venous Thromboembolism in Upper and Lower Extremities
Am J Med
Peripherally inserted central catheters are associated with upper-extremity deep vein thrombosis. Whether they also are associated with lower-extremity deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep...
Peripherally inserted central catheters are associated with upper-extremity deep vein thrombosis. Whether they also are associated with lower-extremity deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep...
Use of Designated PICC Nursing Teams by U.S. Hospitals: A Survey-Based Study
J Pat Saf
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
The Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients
Am J Med
This secondary data analysis of 65,348 patients evaluates whether the Caprini Score is useful to assess VTE risk in medical patients. The analysis found a consistent linear increase in risk in VTE as Caprini Score increased, especially for patients with vascular catheters.
This secondary data analysis of 65,348 patients evaluates whether the Caprini Score is useful to assess VTE risk in medical patients. The analysis found a consistent linear increase in risk in VTE as Caprini Score increased, especially for patients with vascular catheters.
Is Your Doctor Choosing the Right IV?
The Conversation
This op-ed examines the evidence supporting use of IV devices and how doctors use them. The article calls for greater research in IV devices to improve the quality of decision-making and better engage patients role for when making these decisions.
This op-ed examines the evidence supporting use of IV devices and how doctors use them. The article calls for greater research in IV devices to improve the quality of decision-making and better engage patients role for when making these decisions.
Revisiting The Tale of Venous Thrombosis in Hospitalized Medical Patients
J Thrombo Hemostasis
Venous thromboembolism (VTE) leads to substantial morbidity and mortality in hospitalized patients. Yet, data supporting use of prophylaxis in non-critically ill patients remains limited. Here, we review the science and question the wisdom of such wide approaches...
Venous thromboembolism (VTE) leads to substantial morbidity and mortality in hospitalized patients. Yet, data supporting use of prophylaxis in non-critically ill patients remains limited. Here, we review the science and question the wisdom of such wide approaches...
Preventing Vascular Catheter Infections: Time To Get Technical
Lancet
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
The Michigan Appropriates Guide for Intravenous Catheters (MAGIC): Results from a Multi-Specialty Panel Using the RAND/UCLA Appropriateness Method
Ann Intern Med
We convened an international panel and applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. Following systematic review of the literature and consensus from a 15-member expert panel, guidelines for use and care of PICCs were developed.
We convened an international panel and applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. Following systematic review of the literature and consensus from a 15-member expert panel, guidelines for use and care of PICCs were developed.
PICC-Associated DVT: A Narrative Review of the Evidence
Am J Med
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
The Association Between PICC Use and Venous Thromboembolism in Upper and Lower Extremities
Am J Med
Peripherally inserted central catheters are associated with upper-extremity deep vein thrombosis. Whether they also are associated with lower-extremity deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep...
Peripherally inserted central catheters are associated with upper-extremity deep vein thrombosis. Whether they also are associated with lower-extremity deep vein thrombosis or pulmonary embolism is unknown. We examined the risk of venous thromboembolism in deep...
Peripherally Inserted Central Catheter Use in Skilled Nursing Facilities
J Am Geriatr Soc
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization...
Navigating Venous Access: A Guide for Hospitalists
J Hosp Med
Venous access is the foundation for safe and effective hospital-based care. Inpatient providers must have a deep knowledge of the different types of venous access devices (VADs), their relative indications, contraindications, and appropriateness. However...
Venous access is the foundation for safe and effective hospital-based care. Inpatient providers must have a deep knowledge of the different types of venous access devices (VADs), their relative indications, contraindications, and appropriateness. However...
Patterns, Risk Factors and Treatment Associated with PICC-DVT in Hospitalized Adults:
A Nested Case-Control Study
Thromb Res
Peripherally inserted central catheters (PICCs) are associated with upper extremity-deep vein thrombosis (DVT). However, patterns, risk factors and treatment associated with this event remain poorly defined. The objective of this study is to determine patterns, risk factors...
Peripherally inserted central catheters (PICCs) are associated with upper extremity-deep vein thrombosis (DVT). However, patterns, risk factors and treatment associated with this event remain poorly defined. The objective of this study is to determine patterns, risk factors...
Moving the Needle Forward: The Imperative for Collaboration in Vascular Access
J Infus Nurs
Inserting, securing, and maintaining vascular access is a fundamental component of patient care. Whether in the inpatient or ambulatory setting, the ability to infuse medications, obtain lab draws, and administer intravenous fluids in a timely fashion affects patient outcomes...
Inserting, securing, and maintaining vascular access is a fundamental component of patient care. Whether in the inpatient or ambulatory setting, the ability to infuse medications, obtain lab draws, and administer intravenous fluids in a timely fashion affects patient outcomes...
2014 |
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Do Clinicians Know Which of Their Patients Have Central-Venous Catheters?: A Multicenter Observational Study
Ann Intern Med
Complications associated with central venous catheters (CVCs) increase over time. Although early removal of unnecessary CVCs is important to prevent complications, the extent to which clinicians are aware that their patients have a CVC is unknown.
Complications associated with central venous catheters (CVCs) increase over time. Although early removal of unnecessary CVCs is important to prevent complications, the extent to which clinicians are aware that their patients have a CVC is unknown.
Peripherally Inserted Central Catheter-Related DVT: Contemporary Patterns and Predictors
J Thromb Hemostasis
Despite growing use, peripherally inserted central catheters (PICCs) are associated with risk of deep vein thrombosis (DVT). We designed a study to determine patient, provider and device factors associated with this outcome.
Despite growing use, peripherally inserted central catheters (PICCs) are associated with risk of deep vein thrombosis (DVT). We designed a study to determine patient, provider and device factors associated with this outcome.
PICC-Associated Bloodstream Infections: Prevalence, Patterns and Predictors
Am J Med
Growing use of peripherally inserted central catheters (PICCs) has led to recognition of the risk of PICC-associated bloodstream infection. We sought to identify rates, patterns, and patient, provider, and device characteristics associated with this adverse outcome.
Growing use of peripherally inserted central catheters (PICCs) has led to recognition of the risk of PICC-associated bloodstream infection. We sought to identify rates, patterns, and patient, provider, and device characteristics associated with this adverse outcome.
Enhancing Patient-Centered Care: SGIM and Choosing Wisely
J Gen Intern Med
One of the touchstones of academic General Internal Medicine, whether practiced in an ambulatory care setting or at the patient’s bedside, is its focus on enhancing and teaching patient-centered care. In an era of increasing cost consciousness, patient...
One of the touchstones of academic General Internal Medicine, whether practiced in an ambulatory care setting or at the patient’s bedside, is its focus on enhancing and teaching patient-centered care. In an era of increasing cost consciousness, patient...
2013
Hospitalist Experiences, Practice, Opinions and Knowledge Regarding Peripherally Inserted Central Catheters: Results of a National Survey
J Hosp Med
A Michigan survey found variation in hospitalist-reported experience, practice, opinions, and knowledge related to peripherally inserted central catheters (PICCs). Whether these findings reflect a national trend is unknown. Our objective was to investigate self-reported...
A Michigan survey found variation in hospitalist-reported experience, practice, opinions, and knowledge related to peripherally inserted central catheters (PICCs). Whether these findings reflect a national trend is unknown. Our objective was to investigate self-reported...
The Risk of Bloodstream Infection Associated with Peripherally Inserted Central Catheters Compared with Central Venous Catheters in Adults: A Systematic Review and Meta-Analysis
Infect Control Hosp Epidemiol
Peripherally inserted central catheters (PICCs) are associated with central line-associated bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is unknown. Our objective is to compare the risk of CLABSI between PICCs...
Peripherally inserted central catheters (PICCs) are associated with central line-associated bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is unknown. Our objective is to compare the risk of CLABSI between PICCs...
Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheters: A Systematic Review and Meta-Analysis
Lancet
Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis..
Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis..
Hospitalist Experiences, Practice, Opinions and Knowledge Regarding Peripherally Inserted Central Catheters: A Michigan Survey
J Hosp Med
Peripherally inserted central catheters (PICCs) are commonly inserted during hospitalization for a variety of clinical indications. Our objective was to understand hospitalist experience, practice, knowledge, and opinions as they relate to PICCs.
Peripherally inserted central catheters (PICCs) are commonly inserted during hospitalization for a variety of clinical indications. Our objective was to understand hospitalist experience, practice, knowledge, and opinions as they relate to PICCs.
Perceived Strength of Evidence Supporting Practices to Prevent Health Care-Associated Infection: Results From a National Survey of Infection Prevention Personnel
Am J Infect Control
Limited data exist describing the perceived strength of evidence behind practices to prevent common health care-associated infections (HAIs). We conducted a national survey of infection prevention personnel to assess perception of the evidence for various preventive...
Limited data exist describing the perceived strength of evidence behind practices to prevent common health care-associated infections (HAIs). We conducted a national survey of infection prevention personnel to assess perception of the evidence for various preventive...
2012
Recipes for Checklists and Bundles: One Part Active Ingredient, Two Parts Measurment
BMJ Qual Saf
Central venous catheter-related bloodstream infection (CVC-BSI) is common, costly and potentially fatal. For decades, conventional wisdom regarded these infections as inevitable complications of care. This view changed following landmark studies, that demonstrated...
Central venous catheter-related bloodstream infection (CVC-BSI) is common, costly and potentially fatal. For decades, conventional wisdom regarded these infections as inevitable complications of care. This view changed following landmark studies, that demonstrated...
The Problem with Peripherally Inserted Central Catheters
JAMA
Central venous catheters (CVCs) provide reliable venous access for tasks as diverse as delivery of medication, laboratory testing, and hemodynamic monitoring and occupy a fundamental role in the management of seriously ill patients. However, despite their many...
Central venous catheters (CVCs) provide reliable venous access for tasks as diverse as delivery of medication, laboratory testing, and hemodynamic monitoring and occupy a fundamental role in the management of seriously ill patients. However, despite their many...
Bloodstream Infection, Venous Thrombosis and Peripherally Inserted Central Catheters:
Reappraising the Evidence
Am J Med
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization, PICCs...
The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization, PICCs...