Association of Infectious Disease Physician Approval of Peripherally Inserted Central Catheter With Appropriateness and Complications

Key Points Question Is approval by an infectious disease physician prior to placement of a peripherally inserted central catheter (PICC) for intravenous antimicrobials associated with appropriate device use or complications? Findings In this cohort study of 21 653 PICCs placed for intravenous antimicrobials in 42 hospitals, 47% of PICCs were placed with approval of an infectious disease physician. Compared with nonapproved PICCs, approved PICCs were more likely to be appropriately placed, and the patients less likely to experience complications. Meaning This cohort study suggests that infectious disease physician approval of PICCs prior to placement for intravenous antimicrobial therapy is associated with more appropriate device use and fewer complications.
Importance Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous antimicrobial therapy. However, inappropriate PICC use may lead to patient harm. Objective To evaluate whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials is associated with more appropriate device use and fewer complications. Design, Setting, and Participants This cohort study of 21 653 PICCs placed for a primary indication of intravenous antimicrobial therapy between January 1, 2015, and July 26, 2019, was conducted in 42 hospitals participating in a quality collaborative across Michigan among hospitalized medical patients. Main Outcomes and Measures Appropriateness of PICCs was defined according to the Michigan Appropriateness Guide for Intravenous Catheters as a composite measure of (1) single-lumen catheter use, (2) avoiding use of PICCs for 5 days or less, and (3) avoiding use of PICCs for patients with chronic kidney disease (defined as an estimated glomerular filtration rate
This cohort study evaluates whether infectious disease physician approval prior to placement of a peripherally inserted central catheter (PICC) for intravenous antimicrobials is associated with more appropriate device use and fewer complications.