I would like to know what other vascular access professionals think about the MAGIC study and if you are using it to help drive policies in your facility?
MAGIC is being used in almost every state and many other countries. There is now a phone app for it. MAGIC is also heavily referenced in the INS Standards of Practice, so it is a heavily applied set of guidelines.
I was excited to read your post about the phone app and immediately downloaded it. I was disturbed to see that for non chemotherapy vesicant or irritant proposed duration 6-14d recommends BOTH non-tunneled CVC first and PICC second.
Isn't this contradictory to previous recommendations regarding vasoactive agents admin through PICCs as innapropriate?
YES...BUT...organizations are cherry picking what they use out of the MAGIC study. Let us not forget it's the MAGIC study that is prompting hospitals to move away from PICC lines. You are seeing heavy use of Midlines or if a PICC is ordered they are being removed after days because "no longer needed". Big problem clinically. I believe the MAGIC study should be used as a GUIDELINE and not the final clinical answer. It just doesn't go far enough. If your hospital is pushing towards the use of PIV's and Midlines to manage patients ask one question. How many times is it acceptable to stick a patient when the Midline stops giving blood and you can't get a peripheral ?....Now ask yourself, if it was your mother being stuck ...how many times is it acceptable?...hear the crickets?
Inappropriate use of PICCs and shifting to midlines was prominent long before MAGIC. So I don't that is the main driving force. MAGIC promotes appropriate use of all types of VADs. I know many facilities are shifting to inappropriate use of midlines, thinking they can replace a CVAD. That is caused by the financial penalities for CLABSI.
I wouldn't say LONG before the MAGIC study. So I would disagree with that statement. However, it certainly is a movement now. Hospitals not wanting to get "gigged" because of their CLABSI rates should never comprise patient safety, harm. But they are. Again, I will ask what happens when the Midline clots and peripheral access can't be done. That scenario is happening all around the country everyday. We need answers.
I plan to begin reviewing the studies involved later this year. I have been consumed with my doctoral work for a long time. I know some of the recommendations related to the line of choice in critical ill patients is of interest to me. I will reserve my thoughts until later but at first glance I may be missing any strong studies held within that meta-analysis.
MAGIC is not a meta-analysis of multiple clinical studies. It is a Delphi project that used hundreds of scenarios and asked a large group of experts to rank their choices for VADs. The guidelines were developed based on this process.
Sorry, I worded that in a confusing way. I was referring to a meta-analyis that would be assocatied with the MAGIC recommendations... Not the overall project. I'm familiar with the Delphi technique :) I used an ultrasound skill validation tool that was developed with the Delphi approach for my project.
MAGIC is being used in almost every state and many other countries. There is now a phone app for it. MAGIC is also heavily referenced in the INS Standards of Practice, so it is a heavily applied set of guidelines.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi Lynn,
I was excited to read your post about the phone app and immediately downloaded it. I was disturbed to see that for non chemotherapy vesicant or irritant proposed duration 6-14d recommends BOTH non-tunneled CVC first and PICC second.
Isn't this contradictory to previous recommendations regarding vasoactive agents admin through PICCs as innapropriate?
Thank you.
YES...BUT...organizations are cherry picking what they use out of the MAGIC study. Let us not forget it's the MAGIC study that is prompting hospitals to move away from PICC lines. You are seeing heavy use of Midlines or if a PICC is ordered they are being removed after days because "no longer needed". Big problem clinically. I believe the MAGIC study should be used as a GUIDELINE and not the final clinical answer. It just doesn't go far enough. If your hospital is pushing towards the use of PIV's and Midlines to manage patients ask one question. How many times is it acceptable to stick a patient when the Midline stops giving blood and you can't get a peripheral ?....Now ask yourself, if it was your mother being stuck ...how many times is it acceptable?...hear the crickets?
Inappropriate use of PICCs and shifting to midlines was prominent long before MAGIC. So I don't that is the main driving force. MAGIC promotes appropriate use of all types of VADs. I know many facilities are shifting to inappropriate use of midlines, thinking they can replace a CVAD. That is caused by the financial penalities for CLABSI.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I wouldn't say LONG before the MAGIC study. So I would disagree with that statement. However, it certainly is a movement now. Hospitals not wanting to get "gigged" because of their CLABSI rates should never comprise patient safety, harm. But they are. Again, I will ask what happens when the Midline clots and peripheral access can't be done. That scenario is happening all around the country everyday. We need answers.
That is a great point
thanks
I plan to begin reviewing the studies involved later this year. I have been consumed with my doctoral work for a long time. I know some of the recommendations related to the line of choice in critical ill patients is of interest to me. I will reserve my thoughts until later but at first glance I may be missing any strong studies held within that meta-analysis.
Kevin Arnold, MSN, BBA, BS, BSN, RN
Web Manager, www.iv-therapy.net
MAGIC is not a meta-analysis of multiple clinical studies. It is a Delphi project that used hundreds of scenarios and asked a large group of experts to rank their choices for VADs. The guidelines were developed based on this process.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Sorry, I worded that in a confusing way. I was referring to a meta-analyis that would be assocatied with the MAGIC recommendations... Not the overall project. I'm familiar with the Delphi technique :) I used an ultrasound skill validation tool that was developed with the Delphi approach for my project.
Kevin Arnold, MSN, BBA, BS, BSN, RN
Web Manager, www.iv-therapy.net