From the 2018 HVPAA National Conference
Kshitij Thakur (Crozer-Chester Medical Center), Qalb Khan (Capital Health), Naveed Jan (Crozer), FNU Aparna (Crozer-Chester Medical Center), Jian Liang Tan (Crozer-Chester Medical Center), Fnu Anshul (Crozer-Chester Medical Center)
The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) guidelines recommend avoiding use of peripherally inserted central catheters (PICC) if the anticipated duration of use is ≤5 days. Recent studies have shown that despite this recommendation up to 25% of PICCs have a dwell time of ≤5 days.
Primary aim of this study was to identify the percentage of short term PICCs (≤5 days) in our community based teaching hospital. Secondary aim was to identify provider characteristic and common indications associated with short term PICCs
Our team retrospectively reviewed EMR charts of all adult patients that received PICCs during their hospitalization at our hospital in the calendar year 2015. We collected multiple variables including duration of PICC use, ordering provider & indication used for PICC order in the EMR. We assessed appropriateness of PICC use in these patients using the “Michigan MAGIC” phone application.
A total of 621 PICCs were reviewed, 178 (28.6%) were short term PICCs. On review of the short term PICCs, the ordering provider was an IM Resident, Non-Academic Hospitalist and Surgical resident on 72 (40.4%), 73 (41%) and 33 (18.5%) PICCs respectively. Majority (98.3%) of the short term PICCs were removed during the hospitalizations. The indication for PICC use were antibiotic use (56/178), vesicant / parenteral nutrition infusion (5/178), poor IV access (80/178) and frequent blood draws (37/178). Only 5 (2.8%) PICCs were considered appropriate based on the “Michigan MAGIC” application.
Our study showed that short term PICC use is common in our hospital. Very few of these short term PICCs have an appropriate indication. There is no difference in the ordering patterns of teaching and non-teaching services.
Implications for the Patient
PICCs are an expensive resource and involve an invasive procedure. PICCs are associated with complications like central line associated bloodstream infection, venous thromboembolism, catheter occlusion etc. Appropraite use can help reduce these complication and lead to direct and indirect cost savings.