When peripherally inserted central catheters (PICCs) are placed for antimicrobial therapy, infectious disease physician approval is associated with more appropriate device use and a lower risk of complications, a new study found. Researchers examined data on 21,653 patients who received PICCs for antimicrobial therapy at 42 hospitals in Michigan between 2015 and 2019. They assessed the appropriateness of PICC usage based on a composite measure that included single lumen catheter use, use for more than 5 days, and avoiding use in patients with chronic kidney disease. Most PICCs used with approval of an infectious disease physician were appropriate based on this composite measurement (72.7%), compared with fewer than half of PICCs used without this approval (45.4%). With involvement of an infectious disease physician, PICC use was more than three times more likely to be used appropriately (odds ratio 3.53) and much less likely to result in complications (OR 0.55). "What we've learned is that, when you can it's important to get infectious disease physicians involved early," said Dr. Valerie Vaughn, who led the study when she was at the Veterans Affairs Ann Arbor Healthcare Center and the University of Michigan. "If infectious disease physician access is an issue, then it may mean training your PICC insertion team on indications for PICCs and, if a PICC is needed, how to minimize complications by selecting the right device," Dr. Vaughn, who is now at the University of Utah, said by email. PICC-related complications developed in 6.5% of patients who received this intervention based on approval from an infectious disease physician, and in 11.3% of patients who received this without involvement from an infectious disease physician, researchers report in JAMA Network Open. Cases that proceeded without approval from an infectious disease physician were more common when these clinicians were unavailable or accessible via remote consultations than cases that did have infectious disease physician approval, the study also found. Infectious disease physicians were available onsite in 87.1% of cases when they approved PICC lines and in 83.0% of cases in which PICC lines were placed without their approval. One limitation of the study is that researchers lacked data on how approval of PICC by an infectious disease physician impacted usage - or on how often infectious disease physicians advised against PICC use and prevented this, the study team notes. Another drawback is that researchers relied on medical records to assess infectious disease physician involvement, and it's possible that some PICCs involved verbal approvals that were not documented in these records. "While ideally an infectious disease physician would review all patients, it's probably just as important that they work with clinical departments as well as the pharmacy and the PICC inserters to help create new PICC placement policies and automated workflows, and then regularly review audit data with the clinical departments to ensure the policies are being followed," said Claire Rickard, director of the Alliance for Vascular Access Teaching and Research at the Menzies Health Institute Queensland and School of Nursing and Midwifery at Griffith University in Australia. It's also possible that other specialists may be able to help optimize PICC use when infectious disease physicians aren't available for consultations, Rickard, who wasn't involved in the study, said by email. "Nurse practitioners who specialize in infectious disease or vascular access can also provide a model of care that brings together the infectious disease physicians with all these other hospital departments where PICCs are used," Rickard said. —Lisa Rapaport Source
