"miniMAGIC" - New guidelines rate appropriateness of IV devices for sick children

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Children's Health Queensland Hospital and Health Service clinicians, in collaboration with Griffith University and the University of Michigan, have created the world’s first paediatric appropriateness guidelines for intravenous catheters.

Associate Professor Amanda Ullman and colleagues from Griffith University's Menzies Health Institute Queensland worked alongside CHQ nurse practitioner Tricia Kleidon and paediatric surgeon Associate Professor Craig McBride FRACS, along with researchers from the University of Michigan, to develop the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) which rates the safety of all vascular access devices for children.

The primary guide and the entire open access supplement, are published in the journal Pediatrics.

Associate Professor Ullman said the research team distilled the scientific and clinical knowledge from an expert paediatric panel (from leading US and Australian hospitals and universities, including Yale, UCLA, St. Jude Children's Research Hospital, Cincinnati Children's Hospital and the Queensland Children's Hospital) to produce miniMAGIC.

"Almost every child in healthcare needs an IV,'' Associate Professor Ullman said. "They need an IV to receive treatment, from antibiotics and fluids to dialysis. Many children who are chronically ill are IV-dependent for much of their lives. There are a range of IV devices, all with different indications, ranging from short term intra-osseous devices to long-term totally implanted devices. But choosing the wrong IV device can result in harm to children, including infections, delayed treatments and pain."

In addition, she said many children with chronic conditions transition into adulthood with permanent vessel damage, limiting treatment options.

Associate Professor Ullman said that "across the complexity of paediatric healthcare, it's the first time the breadth of paediatric VAD selection and insertion practices have been thoroughly evaluated and critiqued.

"We hope our findings will improve decisions for clinically challenging patients across a broad range of IVs. Because many recommendations are aimed at reducing harm, these appropriateness criteria will help reduce complications related to poor device-selection decisions.

"When faced with a baby with a complex cardiac condition, cancer, or critical illness, all clinicians can now access the miniMAGIC recommendations," she said.

How to ensure Queensland clinicians choose the right IV for all children?

Associate Professor McBride said that miniMAGIC provides an evidence based pathway to guide thought processes regarding vascular access in children. "Fundamentally miniMAGIC should enable clinicians to be proactive rather than reactive, and think about the most appropriate vascular access device from the outset of a child's journey through our healthcare systems. It’s relevant to clinicians treating children all over the state."

Ms Kleidon said that one of the difficulties that a state such as Queensland faces, with a sparse population spread across vast distances, is that a clinician is not always available to insert the "most appropriate device" in all regional facilities. 

“Device choice should be made on the basis of infusion properties, patient characteristics, length of treatment, and current vessel health. The brilliance of miniMAGIC is that no matter where you live in Queensland, whether it is a regional hospital in far north Queensland without vascular access specialists, or in a specialist tertiary centre, clinicians have the same information at their fingertips regarding vascular access choices in children.

miniMAGIC does however provide opportunity to determine the most appropriate device choice and direct or expedite conversations with specialist centres.

"It’s hoped that miniMAGIC will provide an easy to navigate device selection guide that will reduce unnecessary devices, insertion attempts and complications during treatment,” she said.

 

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