Physician Approval Prior to PICC Placement Lowers Complications

Study authors evaluated whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials is associated with more appropriate device use and fewer complications.

Peripherally inserted central catheters (PICCs) delivering intravenous antimicrobial therapy approved by an infectious disease physician was associated with more appropriate device use and fewer complications, according to a study published in JAMA Network Open.

Investigators conducted a cohort study between January 2015 and July 2019, and included 21,653 PICCs placed for primary induction of intravenous antimicrobial therapy. Of the PICCs included, 10,238 (47.3%) had been approved by an infectious disease physician. All 42 of the hospitals in the study had an antimicrobial stewardship program. Of these, 31 facilities (73.8%) reported an infectious diseases physician onsite and 9 facilities (21.4%) had an infectious disease physician available for remote consultation. Approval rates of physicians varied across hospitals, ranging from 1.8% (7/393) to 90.7% (388/428).

PICCs were considered appropriate and were more likely to be approved by an infectious disease physician if they were single-lumen (87% vs 59.7%; P <.001), placed for more than 5 days (95.4% vs 85.8%; P <.001), and placed in patients without chronic kidney disease (87.1% vs 83.3%; P <.001).

Study results showed that PICCs approved by an infectious disease physician met the appropriateness criteria 72.7% of the time, while only 45.4% of PICCs that were not approved met the appropriateness criteria. After adjustments, overall appropriateness (odds ratio [OR], 3.53; 95% CI, 3.29-3.79) and each individual metric of PICC appropriateness remained associated with approval. There was also an association between approved PICCs and lower odds of PICC-related complications (6.5% with approval vs 11.3% without approval; OR, 0.55; 95% CI, 0.50-0.61; P <.001).

The associations of appropriateness and outcomes were reported to be robust in multiple sensitivity analyses. However, study limitations include the inability to assess whether physician consultation prevented PICC placement and lack of documentation for verbal approval of PICC placement.

According to investigators, the data suggest approval by an infectious disease physician prior to PICC placement is associated with better outcomes and more appropriate use. Therefore, policies encouraging physician engagement may improve patient safety, said investigators.


Vaughn VM, O’Malley M, Flanders SA, et al. Association of infectious disease physician approval of peripherally inserted central catheter with appropriateness and complications. JAMA Netw Open. 2020;3(10):e2017659. doi:10.1001/jamanetworkopen.2020.17659