New Guidelines Improve Safety and Effectiveness of IVs for Hospital Patients


“PICCs, or peripherally inserted central catheters, have become especially convenient to place, and their use has gone up dramatically — as have the complications from them,” said Vineet Chopra, MD, MSc, assistant professor of medicine at the University of Michigan, a research scientist with the VA Ann Arbor Healthcare System and lead author of the new guidelines. “The easiest way to prevent these complications is not to place a PICC in the first place. So we set out to determine when the use of a PICC is appropriate, and when other choices are best.”

Scott Woller, MD, co-director of the Thrombosis Clinic at Intermountain Medical Center in Murray, was one of 15 experts from across the country who participated in the research. 

The panel included doctors and nurses from a wide range of fields where PICCs and other similar devices are commonly used, including vascular nursing, anesthesiology, radiology, critical care, hospital medicine, infectious disease, and oncology. A patient who had suffered complications from various IV devices also participated on the panel.

The new tool, known as the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC), now allows clinicians to adopt a standardized approach when they consider placing a PICC line, which will reduce variations in device selection, which is often associated with waste, and facilitate the measurement of important clinical outcomes.

“MAGIC provides a summary of the best practices for PICC insertion, care, and management,” said Dr. Woller, who’s done extensive research in thrombosis and PICCs with Intermountain Healthcare. “Because these tiny tubes are inserted so frequently across the US to deliver lifesaving therapies, standardizing an optimal approach will enhance value for our patients and allow ongoing research to refine the care we provide.”

The MAGIC criteria are based on experts’ reviews of more than 600 scenarios of different kinds of patient and treatments. They provide color-coded charts of algorithms that indicate which devices are appropriate or inappropriate in each case.

Even as they evaluate MAGIC’s ability to reduce variation, improve appropriate use of different device types, and reduce complications, the team behind the new guide hopes other clinicians will begin using it.

They’ve launched a comprehensive website that offers one-stop access to the MAGIC recommendations, which includes information about how clinicians should care for patients who have a vascular access device in the hospital, nursing home, or at home. The site also provides updates on issues and research relates to PICCs, central lines, and other vascular access issues.

“This is very important work,” said Dr. Woller. “Choosing the appropriate device for a given individual limits unnecessary procedures and patient discomfort and adds value to the care we provide. Our goal is to provide the best and most appropriate care possible.These guidelines help us do that."