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      Impact of a midline catheter prioritization initiative on device utilization and central line-associated bloodstream infections at an urban safety-net community hospital

      brief-report
      Author(s): , MD 1 , , , MPH 1 , , MPH 2 , , CIC 2 , , RN 2 , , MD, MBA 2 , , MD 1
      Publication date (Electronic, collection):
      Publication date (Electronic):
      Journal: Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
      Publisher: Cambridge University Press

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          Abstract

          Overuse of peripherally inserted central catheters (PICCs) can lead to idle central line (CL) days and increased risk for CL-associated bloodstream infections (CLABSIs). We established a midline prioritization initiative at a safety-net community hospital. This initiative led to possible CLABSI avoidance and a decline in PICC use.

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          The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method.

          Vineet Chopra, Scott A Flanders, Sanjay Saint … (2015)
          Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients.
          Article 0 comments Cited 128 times – based on 0 reviews     Review now
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            Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence.

            Vineet Chopra, Sarah Anand, Sarah L Krein … (2012)
            The widespread use of peripherally inserted central catheters (PICCs) has transformed the care of medical and surgical patients. Whereas intravenous antibiotics, parenteral nutrition, and administration of chemotherapy once necessitated prolonged hospitalization, PICCs have eliminated the need for such practice. However, PICCs may not be as innocuous as once thought; a growing body of evidence suggests that these devices also have important risks. This review discusses the origin of PICCs and highlights reasons behind their rapid adoption in medical practice. We evaluate the evidence behind 2 important PICC-related complications--venous thrombosis and bloodstream infections--and describe how initial studies may have led to a false sense of security with respect to these outcomes. In this context, we introduce a conceptual model to understand the risk of PICC-related complications and guide the use of these devices. Through this model, we outline recommendations that clinicians may use to prevent PICC-related adverse events. We conclude by highlighting important knowledge gaps and identifying avenues for future research in this area.
            Article 0 comments Cited 65 times – based on 0 reviews     Review now
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              The Midline Catheter: A Clinical Review.

              Daniel Adams, Andrew Little, Charles Vinsant … (2016)
              Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use. The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. Appropriate device selection is warranted on initial patient contact to minimize risk and cost.
              Article 0 comments Cited 27 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Antimicrob Steward Healthc Epidemiol
                Journal ID (iso-abbrev): Antimicrob Steward Healthc Epidemiol
                Journal ID (publisher-id): ASH
                Title: Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
                Publisher: Cambridge University Press (New York, USA )
                ISSN (Electronic): 2732-494X
                Publication date (Electronic, collection): 2024
                Publication date (Electronic): 16 February 2024
                Volume: 4
                Issue: 1
                Electronic Location Identifier: e27
                Affiliations
                [ 1 ]Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago , Chicago, IL, USA
                [ 2 ] Saint Anthony Hospital , Chicago, IL, USA
                Author notes
                Corresponding author: Alfredo J. Mena Lora; Email: amenalor@ 123456uic.edu
                Author information
                https://orcid.org/0000-0003-4853-7272
                Article
                Publisher ID: S2732494X24000214
                DOI: 10.1017/ash.2024.21
                PMC ID: 10897721
                PubMed ID: 38415093
                SO-VID: 4f1aee8f-94cd-4f16-a662-9d85ec40c37d
                Copyright © © The Author(s) 2024
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                Date received : 18 December 2023
                Date revision received : 20 January 2024
                Date accepted : 22 January 2024
                Page count
                Figures: 2, References: 10, Pages: 3
                Categories
                Subject: Concise Communication

                Data availability:

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