Peripherally inserted central catheters: spreading the MAGIC beyond Michigan

Abstract

Central venous access catheters are often used for patients requiring repeated infusions, blood sampling, invasive monitoring or where peripheral access is difficult. For intravenous access of up to 2 weeks in duration, a midline catheter is usually satisfactory, but for longer-term use, peripherally inserted central catheters (PICCs) are increasingly used, including in clinical areas outside of critical care.1 Despite enabling complex care to be delivered more easily, these catheters are associated with significant complications—including central line associated bloodstream infections (CLABSI), venous thromboembolism (VTE) and line occlusion. Such complications can result in poor patient outcomes and are associated with prolonged hospital stays and increased costs of care. In one series of 438 patients with central lines, 61% reported at least one complication, including bloodstream infection.2 Accumulating evidence suggests that being selective about who receives PICC lines, of what type and for what duration, could reduce the frequency of such complications. For example, the use of multilumen PICC lines when a single lumen would suffice is associated with increased early infection and thrombosis.3 In a Canadian study, CLABSI was reported in 5.0% of 907 double-lumen catheters compared with 2.4% of 618 single lumen catheters.3 Thrombosis leading to reinsertion was also much higher with double-lumen lines.3 A simple change in practice of inserting single lumen devices, unless there was clear justification for the contrary, may therefore result in reductions in complications as well as major cost savings. Concurrently, evidence about best practices in implementing interventions to reduce central-line associated complications is also emerging. Critical care units in Michigan, USA, have long demonstrated leadership in research to reduce catheter-related complications. In 2004, Pronovost and colleagues used a package of evidence-based interventions in 108 intensive care units (ICUs) with the aim of reducing CLABSI, including infections associated with PICC lines.4 …

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