Inpatient medicine is one of the most challenging aspects of full scope family medicine. The pace is fast, the patients are truly sick and the rapid patient turnover can make your head spin. With an emphasis on patient disposition and the increasing use of skilled nursing facilities to bridge the gap between hospital and home, patients frequently require IV therapies outside of the hospital. While some patients on long term chemotherapy may receive tunnelled ports, many other patients need a few days to a few weeks of any variety of agents, from simple IV fluids to IV antibiotics to chemotherapy. What form of access should patients receive–peripheral IV, midline, ultrasound guided peripheral IV, central line or a peripherally inserted central catheter (PICC) line?
In our hospital, we have an outstanding “PICC Team” that can quickly come to the bedside and perform any of the above lines. They seem to just “know” what would be best for the patient. However, many inpatient providers may not know what IV line really is the best for a particular patient and may unnecessarily task the PICC team for a type of line when the patient may be fine with a peripheral IV. The Michigan Appropriateness Guidelines for Intravenous Catheters (MAGIC) are part of a statewide effort to improve PICC use. Their MAGIC website details these efforts. They have teamed up with the University of Michigan to produce a step by step algorithm to assist PICC providers and inpatient medicine providers on the proper line for a particular patient/situation. In the past, we have been impressed with a number of the free apps from the UM including Entrain, Nerve Whiz, Neuro Localizer, Anticoagulation Toolkit, Heart Sound Challenge, and EyesHaveIt.
You are a Family Medicine Intern on your inpatient wards rotation. One of your patients is on IV vancomycin for endocarditis and is going to need several weeks of IV antibiotics per your consult with the infectious disease service. Is this patient a good candidate for a PICC line? What if the patient only needs the vancomycin for 3-5 days while in the hospital? Your senior resident asks you to call the hospital PICC team, but first let’s see if the MAGIC PICC from UM app can help!
Evidence based medicine
The MAGIC PICC from UM app provides a simple 5-question algorithm for the appropriate use of PICC lines. The app is based on the MI appropriateness guidelines for PICC use, but doesn’t include a link to those documents or any strength of recommendations or evidence for its recommendations. Nonetheless this information is available online and comes from a reputable source.
What providers would benefit from this App?
PICC nurses/providers, residents, mid-levels, Family Medicine, Internal Medicine, Oncologists, nursing personnel. Any provider who puts in, or orders PICC lines.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Easy to use, intuitive interface.
- Includes some embedded PDFs of additional materials.
- Touch ID login capable.
- Some additional materials internet based while others embedded.
- No references or overall guideline for recommendations included.
- No Android version.
The MAGIC PICC app from UM is a user-friendly addition to the app store that provides PICC providers and inpatient medicine providers a resource for appropriate PICC use. The main limitations of the app are the lack of references/guidelines and lack of an Android version.
- Overall Score
- User Interface
Very easy to use and intuitive, but requires earbuds for best results.
- Multimedia Usage
App has links to some internet and embedded content, but lacks references or other online materials.
A great resource for free.
- Real World Applicability
The MAGIC PICC app from UM would be highly useful for new and even experienced PICC nurses as well as providers who request PICC placement on their patients.
- Device Used For Review
iPhone 6S running iOS 10.3.2
- Available for DownloadiPhoneiPad