Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;31(1):23-30.
doi: 10.1136/bmjqs-2021-013015. Epub 2021 Mar 29.

Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals

Vineet Chopra  1   2   3 , Megan O'Malley  4   3 , Jennifer Horowitz  4   3 , Qisu Zhang  4   3 , Elizabeth McLaughlin  4   3 , Sanjay Saint  4   2 , Steven J Bernstein  3 , Scott Flanders  4   3
Affiliations

Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals

Vineet Chopra et al. BMJ Qual Saf. 2022 Jan.

Abstract

Background: The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.

Methods: A quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (≤5 days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).

Results: Among 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, p<0.001) while complications decreased to 10.7% (absolute difference 4.0%, p=0.001). Compared with patients with inappropriate PICC placement, appropriate PICC use was associated with a significantly lower odds of complications (OR 0.29, 95% CI 0.25 to 0.34), including decreases in occlusion (OR 0.25, 95% CI 0.21 to 0.29), CLABSI (OR 0.61, 95% CI 0.46 to 0.81) and VTE (OR 0.40, 95% CI 0.33 to 0.47, all p<0.01). Patients with appropriate PICC placement had lower rate of complications than those with inappropriate PICC use (incidence rate ratio 0.987, 95% CI 0.98 to 0.99, p<0.001).

Conclusions: Implementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.

Keywords: critical care; healthcare quality improvement; hospital medicine; nosocomial infections.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Bar graph illustrating per cent of PICCs meeting all 3 Appropriateness Criteria in 41 Michigan Hospitals (preintervention vs postintervention). PICC, peripherally inserted central catheter.
Figure 2
Figure 2
Bar graph illustrating per cent of PICCs with complications in 41 Michigan Hospitals (preintervention vs postintervention). PICC, peripherally inserted central catheter.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Climo M, Diekema D, Warren DK, et al. . Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the centers for disease control and prevention. Infect Control Hosp Epidemiol 2003;24:942–5. 10.1086/502163 - DOI - PubMed
    1. Meyer BM. Developing an alternative workflow model for peripherally inserted central catheter placement. J Infus Nurs 2012;35:34–42. 10.1097/NAN.0b013e31823bc8fd - DOI - PubMed
    1. Chopra V, Anand S, Hickner A, et al. . Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013;382:311–25. 10.1016/S0140-6736(13)60592-9 - DOI - PubMed
    1. Ajenjo MC, Morley JC, Russo AJ, et al. . Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients. Infect Control Hosp Epidemiol 2011;32:125–30. 10.1086/657942 - DOI - PubMed
    1. Chopra V, Flanders SA, Saint S. The problem with peripherally inserted central catheters. JAMA 2012;308:1527–8. 10.1001/jama.2012.12704 - DOI - PubMed

Publication types