Use a decision tool to guide the appropriateness of PICC use prior to insertion

Action Items:

• 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.

Resources & Tools: 

• Decision Tools:
  • The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).
    • Video – How to use the MAGIC App
    • Video- The Michigan MAGIC, PICC Appropriateness & Mindful Medicine
    •  App- ImprovePICC MAGIC App
  • Infusion Therapy Standards of Practice 2016 – Overview Presentation
  • Infusion Therapy Standards of Practice 2016 (Paid)
  • ​Vascular Access Dashboard (PICC Excellence)
• Example Inpatient PICC Order set Criteria 
• Tools to Assist with Determining Potential Vesicants
  • INS List of Noncytotoxic vesicant list

• Michigan Medicine List of Medications with Irritant or Vesicant Properties ​

​References: 

• Chopra V, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Annals of Internal Medicine 2015
  • 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.

• Chopra V, et al. Improving Peripherally Inserted Catheter Appropriateness and reducing device -related complications: a quasiexperimental study in 52 Michigan hospitals

• Centers for Disease Control & Prevention Guidelines for Prevention of IV catheter-related infections, 2011 
• SHEA Compendium for preventing catheter-related infections 2014
• Moureau N, et al. Making the MAGIC: Guiding vascular access selection for intensive care – a summary of Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). ICU Management & Practice 2016
  • 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 burden of thrombosis.

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