New Guide Released for Appropriate PICC Use

An international, multi-specialty panel has introduced the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC), a new guide the group hopes will help determine when and how to use peripherally inserted central catheters (PICCs), and related venous access devices.

A team led by Vineet Chopra, MD, MSc, an assistant professor of medicine with the University of Michigan Health System, relied on the RAND/UCLA Appropriateness Method to develop criteria for the use, care, and management of PICCs as well as other venous access devices in adults. The group performed a systematic review of the literature, creating clinical scenarios based on patient population, indication for insertion, and duration of use, comparing the appropriateness of PICC use with other venous access devices in each scenario.
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In total, the panel reviewed 655 scenarios for PICC use. Overall, they rated 38% as appropriate, 19% as neutral or uncertain, and 42% as inappropriate. With this new guide, however, the authors say that clinicians can refer to color-coded figures that summarize the findings in a way that simplifies application at the bedside.

The guide marks the first time that primary care practitioners have been provided guidance “on not only when to use a PICC, but also what other devices they may consider in their patients,” says Chopra, who is also a research scientist with the Ann Arbor VA Medical Center.

In addition, says Chopra, the guide “provides an overview of how best to manage and care for PICCs, such as how often to flush them, how to troubleshoot complications such as occlusion, and how to treated complications such as deep vein thrombosis (DVT).”

Most importantly, the guide provides “new insights on when a PICC is not helpful,” adds Chopra. “Given the enormous pressure on primary care practitioners’ time, I hope the guide will make decision-making easier when it comes to PICCs."

—Mark McGraw

Reference

Chopra V, Flanders S, et al. Michigan Appropriateness Guide for Intravenous Catheters (MAGIC). Ann Intern Med. 2015.