PICC wisely: New best practice guidelines for catheters and IVs

Peripherally inserted catheters (PICCs) have become a popular ways to deliver fluids and medications, yet intravenous devices also can lead to complex infections, blood clots and other complications. Clinical teams from the University of Michigan and the VA Ann Arbor Health System have developed a set of guidelines to govern when and how PICCs are inserted and maintained.

The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides color-coded charts to help clinicians choose the right intravenous method for the specific clinical need and duration, based on hundreds of scenarios and outcomes. The guidelines, modeled on the RAND/UCLA Appropriateness Method used in many other clinical research applications, are the first endeavor to outline best practices for the use of intravenous access methods.

"PICCs have become especially convenient to place, and their use has gone up dramatically–as have the complications from them,” said lead author Vineet Chopra, MD, MSc., in a University of Michigan press release [pictured right]. “The easiest way to prevent these complications is not to place a PICC in the first place. So we set out to determine when the use of a PICC is appropriate, and when other choices are the best."

Researchers examined 665 scenarios where PICCs were used and found that 43 percent of them were considered inappropriate considering the intended use or the intended duration, notes the study, published in the Annals of Internal Medicine. Literature reviews revealed considerable variation in the use of IV devices, even for the same conditions.  

The study revealed the need for more research on specific scenarios, including those who require frequent blood draws and those who require an intravenous device for long-term care.

"The evidence in this area is fragmented and much of it has been generated by nurses, interventional radiology and others,” Chopra notes in a blog on the MAGIC site.  As you can imagine, with the cultural shifts between nursing and physicians, there's lots of disagreement about what device, when and why.

The team’s guidelines are already being tested at 47 hospitals across Michigan and in the state’s Veteran Affairs health system.  The Infusion Nurses Society plans to update its national standards based on MAGIC’s recommendations, the press release notes.

Skilled nursing facilities are already feeling pressure to provide IV therapy services to reduce unnecessary hospitalizations and to provide fuller services to residents onsite. But as services grow, skill sets also must grow–many SNFs don't have registered nurses on staff 24/7, should something go wrong with an intravenous insertion line, notes a New York Times feature on IV services in nursing homes.

For more information on improving PICC applications and resident safety, see the Improve PICC page.


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