Don’t place, or leave in place, peripherally inserted central catheters for patient or provider convenience.
Peripherally inserted central catheters (or “PICCs”) are commonly used devices in contemporary medical practice that are associated with costly and potentially lethal health care-acquired complications: most commonly central-line associated bloodstream infection and venous thromboembolism. Given the clinical and economic consequences of these complications, placement of PICCs should be limited to acceptable indications (e.g., long-term peripherally compatible infusions, non-peripherally compatible infusions, chemotherapy, palliative care and frequent blood draws). PICCs should be promptly removed when acceptable indications for their use ends.
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An ad hoc committee of the Society of General Internal Medicine (SGIM) was impaneled, taking advantage of the clinical expertise of members from the Clinical Practice Committee and Evidence-Based Medicine Task Force within the Society. Members of the ad hoc committee were then solicited to determine possible topics for consideration. The topics chosen were selected to meet the goals of the Choosing Wisely campaign, utilizing the unique clinical perspective of members of the Society in ambulatory general medicine as well as hospital-based practice. The final topics were selected by a vote of committee members based on the strength of the existing evidence, the unique standing members of the Society have in addressing the clinical topics selected, as well as contributions the recommendations would make in terms of patient safety, quality and economic impact. The final recommendations were approved by the governing Council of SGIM.
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Chopra V, Anand S, Krein SL, Chenoweth C, Saint S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence.Am J Med. 2012;125(8):733-74.
Chopra V, Anand S, Hickner A, Buist M, Rogers MA, Saint S, Flanders SA. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet. 2013 May 17; pii: S0140-6736(13)60592-9. ePub ahead of print.
Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest. 2005;128(2):489-95.
Tejedor SC, Tong D, Stein J, Payne C, Dressler D, Xue W, Steinberg JP. Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “Idle central venous catheter”. Infect Control Hosp Epidemiol. 2012 Jan;33(1):50-57.