Use a decision tool to guide the appropriateness of PICC use prior to insertion
Identify, adapt and deploy a decision-tool to guide clinicians in determining the appropriateness of CVC or PICC placement prior to insertion
Ensure that the decision to use a PICC is made in consultation with operators familiar with recommendations from the decision tool;
Designate a physician champion to support use of the decision tool and assist with resolving disagreements between inserter and ordering physician or managing uncertainty regarding best practice
Share the proposed decision tool with front-line clinicians and members of the vascular access committee to ensure buy-in and feedback of the tool
Communicate use of decision-tool to clinicians and front line staff through educational sessions (morning report, grand rounds, nursing huddles/blitzes, etc.)
Implement the decision-tool via approaches such as a nursing checklist for PICC use vs. use of other non-central venous access devices, computerized decision support within the electronic health system, etc.
Criteria for the use of PICCs was developed, adopting the RAND/UCLA Appropriateness Method. After a review of 665 scenarios, 43% of PICCs were flagged as inappropriate. Applying these criteria as a guide can help decrease the likelihood of an inappropriate catheter, improve care, and inform quality improvement efforts.
Adoption of a vascular access nurse led catheter program, coupled with device selection algorithms, contributes to the ability to select the right device for the patient, while decreasing excess central line usage without additional increased risks to the patient.
MAGIC provides guidance through which to assess the appropriateness of PICCs and other vascular access devices for the intensive care patient. Application of MAGIC by clinicians and providers within intensive care areas may assist hospitals in establishing reliable access, improving outcomes, achieving infection prevention goals and reducing the burden of thrombosis.
This study suggests that, when PICCs were placed for intravenous antimicrobial therapy, infectious disease physician approval of PICC insertion was associated with more appropriate device use and fewer complications. Policies aimed at ensuring infectious disease physician approval prior to PICC placement for antimicrobials may improve patient safety.