Assessment of the MAGIC recommendations in context of evolving evidence based on the use of PICC in ICU.

The goal of the 2015 Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was to define indications and appropriate practices for peripherally inserted central catheters (PICC) use; however, MAGIC recommendations virtually reduced the use of PICC in hospital settings, including critical care. The aim of this review is to present an assessment of the MAGIC guidelines, considering contemporary evidence to date. The validity of the MAGIC recommendations and their applicability to current practice are called into question given important concerns with the methodology for their development (e.g. high volume of clinical scenarios for evaluation) and the supporting evidence used. There is a considerable amount of contemporary evidence not considered in MAGIC that reports on evolving practices, techniques, and technologies targeted to reduce complications associated with central venous access devices (CVADs). Recent evidence dictates that CVADs are necessary in the intensive care unit (ICU), and that PICCs are a safe, reliable, and appropriate type of central lines, which cannot be replaced in several ICU situations. In light of evolving evidence and practice, as well as the methodological concerns identified, the MAGIC guidelines should be revisited. It is also recommended to create a clinical assessment tool that identifies potential uses of specific CVADs, based on patient needs. The choice of the CVAD should be based on unique clinical considerations and current scientific evidence, not on fears informed by antiquated data.

Cost containment and infusion services.

The implementation of the Medicare Prospective Payment System (MPPS) has placed pressure on healthcare organizations to decrease patient length of stay without adversely affecting outcomes. This article discusses the impact of the MPPS on clinicians who provide infusion therapy, and examines methods for containing costs related to infusion care such as advanced planning and accurate vascular access device selection.

Cost losses associated with the "PICC, stick, and run team" concept.

Covenant Healthcare System is a 500-bed facility in Saginaw, Michigan. A peripherally inserted central catheter (PICC) program was instituted there in 1990 when it was St. Lukes Hospital. Over the course of 17 years, 30 nurses had been trained to place PICCs in their spare time. A "PICC, stick, and run team" was established in 1998 but was unsuccessful. After a merger with Saginaw General Hospital, Covenant Healthcare created two full-time vascular access specialty positions. This nursing-based PICC program with full-time staffing has revitalized vascular access at Covenant Healthcare System. Currently, PICCs are placed proactively at the beginning of hospital stays. Peripheral catheter restarts have been replaced with reliable PICC access sites. Delayed discharge for PICC insertion is no longer an issue.