Evaluating the Use of Peripherally Inserted Central Catheters in Pediatrics: Findings from a Multisite Study

Introduction:
Peripherally inserted central catheters (PICCs) are vital for administering long-term intravenous therapies in pediatric patients. However, their use must align with guidelines to ensure safety and efficacy.

Background:
A multisite study was conducted to assess how the use of PICCs in hospitalized children aligns with the Michigan Appropriateness Guide for Intravenous Catheters (miniMAGIC) in Children recommendations. This study aimed to explore variations across sites and identify instances of inappropriate PICC usage.

Current Practices:
The retrospective study included data from four children's hospitals in the United States, covering the period from January 2019 to December 2021. PICCs were categorized based on their appropriateness: inappropriate, uncertain appropriateness, and appropriate.

Key Findings:

- Out of 6,051 PICCs identified, 9% were inappropriate, 9% were of uncertain appropriateness, and 82% were appropriate.
- The study observed a downward trend in PICC usage over time. However, up to 20% of PICCs each year were not appropriate, with significant variation between sites.
- Among the inappropriate or uncertain appropriateness PICCs, the median patient age was 4 years, and 54% were male. The main reason for PICC placement was prolonged antibiotic therapy (56%).
- The most common admitting services requesting inappropriate/uncertain PICCs were critical care (24%), general pediatrics (22%), and pulmonary (20%).
- Complications leading to PICC removal occurred in 6% of cases, with dislodgement (3%) and occlusion (2%) being the most frequent issues. Infection and thrombosis rates were 1% each.

Conclusion:
While most PICCs met the appropriateness criteria, a significant proportion were deemed inappropriate or of uncertain appropriateness. This highlights an opportunity for quality improvement to ensure better adherence to guidelines.

Authors: Alina G. Burek, Mary Beth Davis, Brittany Pechous, Erin E. Shaughnessy, Katie A. Meier, Sarah Mooney, Dana Woodruff, Meaghan Bruner, Laura Piper, Melodee Liegl, Amy Pan, David C. Brousseau, Amanda J. Ullman

Read More: https://pubmed.ncbi.nlm.nih.gov/38404202/