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Making MAGIC: how to improve the use of peripherally inserted central catheters
  1. Vineet Chopra
  1. Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Vineet Chopra, Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; vineetc{at}

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At this very moment, somewhere in the world, an intravenous catheter is being placed in a hospitalised patient. Whether the device is small and being placed in a vein in the arm (eg, peripheral intravenous catheter) or large and inserted into a great vessel within the chest (eg, implanted port), they share several characteristics. First, they are all designed to deliver potentially life-saving therapies such as antibiotics, fluids and nutrition or blood products. Indeed, safe and reliable venous access is a cornerstone to medical care in the 20th century. Second, in order to access the venous network, they must penetrate through the skin to provide a pathway to the bloodstream. Consequently, they each carry a risk of both infectious and non-infectious complications. Thus, to keep patients safe, selecting the most appropriate device—one that balances risks against benefits—is paramount to ensure optimal outcomes.

While this statement may seem obvious, evidence suggests that clinical practice is far from this ideal. For example, in a study of hospitalised children who received peripherally inserted central catheters (PICC), a large proportion experienced multiple PICC insertions, short dwell times (eg, PICCs placed for difficult venous access) and premature removals (eg, because of failure or lack of clear indication), increasing the risk of harm.1 In another study of hospitalised adults, patients with PICCs were found to have multiple days where the device was not used, exposing patients to complications without therapeutic benefit.2 These aberrations in best practice are not unique to PICCs. For instance, in a global study examining patterns of peripheral intravenous catheter use, two-thirds of all surveyed devices were placed in a non-recommended site, had signs and symptoms of malfunction or were idle without a clear indication for continued use.3 Similarly, despite the risk of thrombosis associated with PICCs in patients with …

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