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Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data. | LitMetric

AI Article Synopsis

  • A study reviewed PICC (Peripherally Inserted Central Catheter) use among general medicine patients in five Toronto hospitals to see how well it aligned with the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).
  • Of the 3,479 PICC placements analyzed, 53% were deemed appropriate, while 16% were inappropriate, with the remainder classified as uncertain, highlighting variability in usage across hospitals.
  • The findings indicated that patients with certain characteristics, like older age and more severe illnesses, were more likely to receive inappropriate PICC placements, emphasizing the need for better adherence to clinical guidelines in medical practice.

Article Abstract

Background: Peripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).

Methods: This was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use.

Results: Among 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC.

Conclusions: Clinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.

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Source
http://dx.doi.org/10.1136/bmjqs-2019-010463DOI Listing

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