References:
- Chopra, V. et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness MethodAnnals of Internal Medicine 2015.
- Criteria for the use of PICCs was developed, adopting the RAND/UCLA Appropriateness Method. After a review of 665 scenarios, 43% of PICCs were flagged as inappropriate. Applying these criteria as a guide can help decrease the likelihood of an inappropriate catheter, improve care, and inform quality improvement efforts.
- Timsit, J. et al.Expert Consensus-Based Clinical Practice Guidelines Management of Intravascular Catheters in the Intensive Care Unit. Annals of Intensive Care 2020.
- The French Society of Intensive Care Medicine established 36 guidelines for managing central venous, arterial, and dialysis catheters in ICUs using the GRADE methodology, emphasizing infection prevention through subclavian vein use and one-step chlorhexidine-alcohol disinfection. Recommendations suggest avoiding antiseptic or antibiotic-impregnated CVCs and advise using ultrasound guidance to minimize complications, while also proposing specific pediatric strategies and future areas for investigation. A NEJM randomized trial that included both critically ill and non-critically ill adults and children assigned 1098 individuals undergoing PICC placement to receive a hydrophobic PICC, a chlorhexidine PICC, or a standard polyurethane PICC (1:1:1 ratio). The risk of device failure due to noninfectious or infectious complications similar for hydrophobic or chlorhexidine PICCs compared with standard polyurethane PICCs. Device failure occurred in 5.9 percent of the hydrophobic group, 9.9 percent in the chlorhexidine group, and 6.1 percent in the standard-polyurethane group. However, more complications from any cause occurred for chlorhexidine compared with standard polyurethane catheters (OR 2.35, 95% CI, 1.68 to 3.29).
- Takashima, M. et al. Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings SCCM 2018.
- The study systematically reviewed 63 studies to examine failure rates and complications of central venous access devices in adult ICUs, finding a 5% overall failure rate, with hemodialysis catheters experiencing the highest failure and non-tunneled devices showing the highest infection rates. Despite relatively low rates of bloodstream infections, a significant proportion of devices were removed due to suspected infections, highlighting the need for more comprehensive guidelines to better inform the decision-making process in suspected infection cases.