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Published on: July 13, 2019
Inappropriate Use of Peripherally Inserted Central Catheters in Pediatrics: A Multisite Study
Alina G Burek1,2, Mary Beth Davis3,4, Brittany Pechous3
1Children's Wisconsin, Milwaukee, Wisconsin.
Insights
While most peripherally inserted central catheters (PICCs) were appropriate, a significant number were not. This highlights an opportunity to improve PICC use in hospitalized children through quality initiatives.
Area of Science:
- Pediatric hospital medicine
- Vascular access devices
- Healthcare quality improvement
Background:
- Peripherally inserted central catheters (PICCs) are widely used in pediatric hospital settings.
- Standardized guidelines, such as the Michigan Appropriateness Guide for Intravenous Catheters (miniMAGIC) in Children, aim to optimize PICC utilization.
- Variations in PICC use and appropriateness across institutions necessitate evaluation.
Purpose of the Study:
- To assess the alignment of current PICC practices in hospitalized children with miniMAGIC in Children guidelines.
- To identify variations in PICC appropriateness across different clinical sites.
- To characterize children receiving PICCs that do not meet appropriateness criteria.
Main Methods:
- Retrospective study at 4 US children's hospitals (January 2019-December 2021).
- Included hospitalized children with PICCs (excluding NICU patients).
- Categorized PICCs as appropriate, inappropriate, or uncertain appropriateness using miniMAGIC criteria.
Main Results:
- Of 6051 PICCs, 82% were appropriate, 9% inappropriate, and 9% uncertain.
- Up to 20% of PICCs annually were not appropriate, with inter-site variability.
- Inappropriate/uncertain PICCs (n=1100) were often for prolonged antibiotic courses (56%) and associated with complications (6%), mainly dislodgement (3%) and occlusion (2%).
Conclusions:
- The majority of PICCs met appropriateness criteria, but a notable proportion did not.
- Significant opportunities exist for quality improvement in PICC utilization among hospitalized children.
- Further research and targeted interventions can optimize PICC use and reduce associated complications.
Objectives:
This study aimed to describe how the current practice of peripherally inserted central catheter (PICC) use in hospitalized children aligns with the Michigan Appropriateness Guide for Intravenous Catheters (miniMAGIC) in Children recommendations, explore variation across sites, and describe the population of children who do not receive appropriate PICCs.
Methods:
A retrospective study was conducted at 4 children's hospitals in the United States. Children with PICCs placed January 2019 to December 2021 were included. Patients in the NICU were excluded. PICCs were categorized using the miniMAGIC in Children classification as inappropriate, uncertain appropriateness and appropriate.
Results:
Of the 6051 PICCs identified, 9% (n = 550) were categorized as inappropriate, 9% (n = 550) as uncertain appropriateness, and 82% (n = 4951) as appropriate. The number of PICCs trended down over time, but up to 20% of PICCs each year were not appropriate, with significant variation between sites. Within inappropriate or uncertain appropriateness PICCs (n = 1100 PICC in 1079 children), median (interquartile range) patient age was 4 (0-11) years, 54% were male, and the main reason for PICC placement was prolonged antibiotic course (56%, n = 611). The most common admitting services requesting the inappropriate/uncertain appropriateness PICCs were critical care 24%, general pediatrics 22%, and pulmonary 20%. Complications resulting in PICC removal were identified in 6% (n = 70) of inappropriate/uncertain PICCs. The most common complications were dislodgement (3%) and occlusion (2%), with infection and thrombosis rates of 1% (n = 10 and n = 13, respectively).
Conclusions:
Although the majority of PICCs met appropriateness criteria, a substantial proportion of PICCs were deemed inappropriate or of uncertain appropriateness, illustrating an opportunity for quality improvement.
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