Study Shows Significant Variation in PICC Use

The use of peripherally inserted central catheters (PICCs) may vary widely across hospitals and is not explained by the severity of patient illness or by any hospital-level factors, according to a research letter published Feb. 15 in JAMA Internal Medicine.

The prospective study, analyzed by Vineet Chopra, MD, MSc, et al., was conducted at 10 Michigan hospitals through the Michigan Hospital Medicine Safety Consortium with the goal of learning about variation in PICC use or outcomes across hospitals. Data on 3,378 PICCs placed in 3,201 patients were available.

Results showed that the volume of PICC use ranged widely among hospitals – from 73 to 479 devices. Indications for PICC placement also varied considerably, as did the frequency of PICC complications. The median dwell time for PICCs was 10 days. However, 24.2 percent of PICCs were removed within five days.

In addition, a PICC-related complication occurred in 19.1 percent of cases. Catheter occlusion was the most frequent complication, occurring in 10.1 percent of cases. Symptomatic deep vein thrombosis and pulmonary embolism occurred in 5.2 percent of cases and were more frequent in patients in the ICU compared with non-ICU settings.

Because these substantial variations are not explained by severity of patient illness or by any hospital-level factors, the authors explain that further study is needed to understand their connection, if any, to the numerous complications associated with PICCs. Further, because nearly a quarter of PICCs were removed within five days of insertion, Chopra, et al., conclude that guidance to better inform physicians about when a PICC may be appropriate is necessary.

To that end, the authors explain that the recently developed Michigan Appropriateness Guide for Intravenous Catheters guidelines can be used, which include appropriateness ratings and key recommendations along with algorithmic decision trees tailored to clinical parameters.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Interventions and Vascular Medicine

Keywords: Catheterization, Peripheral, Intensive Care Units, Michigan, Prospective Studies, Pulmonary Embolism, Venous Thrombosis

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