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Appropriateness of peripherally inserted central catheter use among general medical inpatients: an observational study using routinely collected data
  1. Amol A Verma1,2,3,
  2. Alexander Kumachev2,
  3. Sonam Shah2,
  4. Yishan Guo1,
  5. Hae Young Jung1,
  6. Shail Rawal2,4,
  7. Lauren Lapointe-Shaw2,4,
  8. Janice L Kwan2,5,
  9. Adina Weinerman2,6,
  10. Terence Tang2,7,
  11. Fahad Razak1,2,3
  1. 1 Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
  2. 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4 Department of Medicine, University Health Network, Toronto, Ontario, Canada
  5. 5 Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
  6. 6 Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  7. 7 Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
  1. Correspondence to Dr Amol A Verma, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON M5B 1W8, Canada; amol.verma{at}


Background Peripherally inserted central catheters (PICC) are among the most commonly used medical devices in hospital. This study sought to determine the appropriateness of inpatient PICC use in general medicine at five academic hospitals in Toronto, Ontario, Canada, based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC).

Methods This was a retrospective, cross-sectional study of general internal medicine patients discharged between 1 April 2010 and 31 March 2015 who received a PICC during hospitalisation. The primary outcomes were the proportions of appropriate and inappropriate inpatient PICC use based on MAGIC recommendations. Hospital administrative data and electronic clinical data were used to determine appropriateness of each PICC placement. Multivariable regression models were fit to explore patient predictors of inappropriate use.

Results Among 3479 PICC placements, 1848 (53%, 95% CI 51% to 55%) were appropriate, 573 (16%, 95% CI 15% to 18%) were inappropriate and 1058 (30%, 95% CI 29% to 32%) were of uncertain appropriateness. The proportion of appropriate and inappropriate PICCs ranged from 44% to 61% (p<0.001) and 13% to 21% (p<0.001) across hospitals, respectively. The most common reasons for inappropriate PICC use were placement in patients with advanced chronic kidney disease (n=500, 14%) and use for fewer than 15 days in patients who are critically ill (n=53), which represented 14% of all PICC placements in the intensive care unit. Patients who were older, female, had a Charlson Comorbidity Index score greater than 0 and more severe illness based on the Laboratory-based Acute Physiology Score were more likely to receive an inappropriate PICC.

Conclusions Clinical practice recommendations can be operationalised into measurable domains to estimate the appropriateness of PICC insertions using routinely collected hospital data. Inappropriate PICC use was common and varied substantially across hospitals in this study, suggesting that there are important opportunities to improve care.

  • hospital medicine
  • health services research
  • quality measurement

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  • Contributors The study was designed by AAV, AK, SS and FR. YG and HYJ conducted the statistical analysis. AAV, YG, HYJ, SR, LLS, JLK, AW, TT and FR contributed to data collection. AAV wrote the first draft of the manuscript and all authors contributed to critical interpretation of the analysis and revised the manuscript for important intellectual content.

  • Funding This study was funded by Green Shield Canada Foundation and Mak Pak Chiu and Mak-Soo Lai Hing Chair in General Internal Medicine.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the research ethics board at all participating hospitals.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The study’s lead investigators will make data for this manuscript available upon request as possible in compliance with local research ethics board requirements and data sharing agreements.

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