The MAGIC – Guide for PICC Use

MAGIC – stands for Michigan Appropriateness Guide for Intravenous Catheters. This guide (Table 2)  was published in the Annals of Internal Medicine, September 15, 2015. See reference below.

Appropriate indications for PICC use
1. Delivery of peripherally compatible infusates when the proposed duration of such use is ≥6 d*

2. Delivery of non–peripherally compatible infusates (e.g., irritants or vesicants), regardless of proposed duration of use

3. Delivery of cyclical or episodic chemotherapy that can be administered through a peripheral vein in patients with active cancer, provided that the proposed duration of such treatment is ≥3 mo†

4. Invasive hemodynamic monitoring or requirement to obtain central venous access in a critically ill patient, provided the proposed duration of such use is ≥15 d‡

5. Frequent phlebotomy (every 8 h) in a hospitalized patient, provided that the proposed duration of such use is ≥6 d

6. Intermittent infusions or infrequent phlebotomy in patients with poor/difficult peripheral venous access, provided that the proposed duration of such use is ≥6 d§

7. For infusions or palliative treatment during end-of-life care||

8. Delivery of peripherally compatible infusates for patients residing in skilled nursing facilities or transitioning from hospital to home,provided that the proposed duration of such use is ≥15 d¶

Inappropriate indications for PICC use
1. Placement for any indication other than infusion of non–peripherally compatible infusates (e.g., irritants or vesicants) when the proposed duration of use is ≤5 d

2. Placement in a patient with active cancer for cyclical chemotherapy that can be administered through a peripheral vein, when the proposed duration of such treatment is ≤3 mo and peripheral veins are available

3. Placement in a patient with stage 3b or greater chronic kidney disease (estimated glomerular filtration rate ≤44 mL/min) or in patients currently receiving renal replacement therapy via any modality

4. Insertion for nonfrequent phlebotomy if the proposed duration of such use is ≤5 d

5. Patient or family request in a patient who is not actively dying or in hospice, for comfort in obtaining daily blood samples for laboratory analysis

6. Medical or nursing provider request in the absence of other appropriate criteria for PICC use

Foot Notes:

* Use of ultrasonography-guided peripheral intravenous catheters or midlines is preferred over use of PICCs for infusion of peripherally compatible infusates up to 14 d. In patients with poor peripheral venous access, use of ultrasonography-guided peripheral intravenouscatheters and midlines is also preferred over use of PICCs.
† In patients with cancer, the risk for thrombosis associated with PICCs may outweigh benefits. Patients who are scheduled to receive multiple cycles of peripherally compatible chemotherapy for durations ❤ mo should do so via peripheral intravenous catheters with each infusion.
‡ Use of nontunneled central venous catheters is preferred over use of PICCs for central venous access or invasive hemodynamic monitoring<14 d and in patients with documented hemodynamic instability where urgent venous access is necessary.
§ Use of ultrasonography-guided peripheral intravenous catheters or midlines is preferred over use of PICCs for patients with poor/difficult peripheral venous access.
||Placement of a PICC in a terminally ill patient is appropriate if it facilitates comfort goals of care. PICCs may be left in place in such patients to attain similar goals.
¶ Use of PICCs for home-based infusions or in skilled nursing facilities (where resources are limited) is inappropriate for short-term durations(<14 d). In such settings, use of peripheral intravenous catheters or midlines was rated as appropriate.

_______

Reference: Chopra V, Flanders SA, Saint S, Woller SC, O’Grady NP, Safdar N, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015;163:S1-S40. doi:10.7326/M15-0744