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A Retrospective Analysis of the Educational Benefits of a PICC Insertion Training Program
A Retrospective Analysis
of the Educational Benefits ofa PICC Insertion Training Program Tess Angeles, BSN Marijane Barbone, RN
Perivascular Nurse Consultants, Inc., has been training nurses on proper insertion techniques and maintenance procedures for Peripherally Inserted Central Catheters (PICC) since 1989. Our mission is to educate nurses to safely, properly, and confidently insert PICC lines. In 1993, we surveyed the nurses who had attended the program to solicit their opinions concerning the appro~ priateness and effectiveness of the program content.
components that needed further explanation or expan~ sion, reasons the participant was not actively inserting PICC lines, number of catheters inserted by the partici~ pant, success rates, and identification of the most com~ mon reason that the participant experienced PICC insertion failure.
Survey Results Survey Method Two hundred participants were surveyed retrospectively at three~ and six~month intervals following attendance at a program. The purpose of the survey was to deter~ mine whether the training program that they had attended was beneficial when actually inserting and managing PICC lines. The survey consisted of 15 multiple~choice ques~ tions (Figure 1). The questions included demographic information, reasons the participants attended the pro~ gram, identification of the course components that were felt to be most helpful, identification of the course
The overall response to the survey was excellent; 17% (69) of the surveys sent were completed and returned. The study demographics indicated that 75% (52) of the participants who responded were employed outside the hospital setting and that 43% (30) worked at a staff nurse level. Of the surveys returned, 95% (66) of the respondents considered the training program helpful and necessary, which validated the need for educational programs. In evaluating the reasons that participants attended the program, the responses were quite varied. thirty~eight percent (26) were required to attend the program by their place of employment in order to place PICC lines, 26% (18) attended the program for infor~
Tess Angeles, BSN, is the vice president of Perivascular Nurse Consultants, Inc., located in Rockledge, Pennsylvania. Ms. Angeles has extensive experience in developing educational programs and materials and in placing PICC lines. Marijane Barbone, RN, is a clinical nurse educator for Perivascular Nurse Consultants, Inc., located in Rockledge, Pennsylvania. Ms. Barbone has had extensive experience training and supervising nurses in the care and management and insertion procedures for PICe lines.
16
JVAD
Volume 1, Number 1 1995
SURVEY QUESTIONS 1. Your place of employment is? a. b. c. d. e.
Hospital setting Clinic..outpatient Homecare Home infusion Other (specify)
2. Your position at your place of employment? a. b. c. d.
Staff Administrator Clinical specialist Other (specify)
3. What was your reason for taking the PICC training program?
a. For my own knowledge. I have no intentions at present to place PICCs b. Because my employer required it. We will be required to place and manage PICCs c. Because my employer required it. We will only be managing PICCs at work d. Because I want to seek employment in the future that requires the course
6. Which part of the course did you find most helpful? a. b. c. d. e. f. g. h.
Video Complications Anatomy Legal aspects Lecture/slides specific to procedure Nursing management Insertion technique Other (specify)
7. Are there any parts of the PICC course you found needed to be expanded upon to help you more in clinical practice? a. b. c. d. e. f. g. h.
Video Complications Anatomy Legal aspects Lecture/slides specific to procedure Nursing management Insertion technique Other (specify)
8. Have you started PICC lines where you work? a. Yes (answer 8a) b. No (answer 8b)
4. Do you feel the course was necessary for you to be able to place a PICC? a. Yes b. No (explain)
5. Did you find the PICC course helpful in your work? a. Very helpful b. Somewhat helpful c. Not at all helpful
8a. If you answered yes to question 8, how much time lapsed between the time you took the PICC course and your first attempt at placing a PICC line? a. b c. d.
Less than one month 1-3 months 4-6 months More than 7 months
8b. If you answered no to question 8, circle all appro.. priate answers. a. b. c. d.
Place of work does not place PICC lines Have not had the opportunity to place PICC lines Do not feel comfortable placing a PICC line Feel comfortable with course knowledge but hesitant to actually perform procedure
FIGURE 1 Survey Questions.
JVAD
Volume 1, Number 1 1995
17
9. On average, how many PICC lines have you started per month? a. b. c. d.
0-5 6-10 11-15 > 16
10. Do you use guidewire to insert PICC lines? a. Yes b. No
11. Which introducer do you prefer? a. Breakaway needle b. Peelable sheath
12. When placing PICC lines, your success rate is approximately? a. 90%-100% b.60%-90% c. 40%-60% d. < 40%
13. What is the most common reason for PICC insertion failure? a. b. c. d. e.
Unable to insert introducer Unable to thread catheter Equipment defect (specify) Uncooperative client Other (specify)
FIGURE 1 (cont'd)
mational purposes only and did not intend to place PICC lines, 25% (17) were required to attend the pro.. gram by their employer in order to manage PICC lines, and 10% (7) attended the program to assist in seeking employment that requires training in PICC insertion and management techniques (Figure 2). The PICC training program was then divided into curriculum components. Forty percent (28) of the par.. ticipants who responded felt that all of the program components were beneficial, 38% (26) felt that the in.. formation and demonstration of insertion techniques were of most value, and 28% (19) of the participants felt that the lecture and slides presented, which were specific to the procedure, provided the most benefit. The participants were asked to identify the compo.. nent of the training curriculum that needed expansion. Twenty.. three percent (16) of the participants indicated that no change to the curriculum was necessary, 17% (12) felt that nursing management needed expansion, 14% (10) of the participants indicated that the insertion tech.. nique component needed further review, and 10% (7) in.. dicated that both the complications of PIce line therapy and anatomy components required further review. Six months following attendance at the program, 62 % (43) of the participants who responded to the sur.. vey had not inserted a PICC line (Figure 3). Fifty.. five
18
percent (38) indicated that they did not have the op'" portunity to insert a PICC line, 43% (30) of the partici.. pants felt comfortable with their knowledge base in PICC lines but were either hesitant at performing the procedure or their employer did not require them to place PICC lines, and 5% (3) did not feel comfortable with the procedure. Of the 38% (26) participants who have inserted PICC lines, 60% (16) were successful with insertion 90% to 100% of the time (Figure 4). Thirty.. seven per.. cent (10) participants indicated that the most common reason for unsuccessful insertion was due to an inability to thread the catheter; 20% (5) were unsuccessful be.. cause the patients were uncooperative; 13% (3) of the participants were unable to insert the introducer; and 30% (8) of the participants indicated they were unsuc.. cessful with insertion due to a variety of reasons, which include product defect, inappropriate patient selection, poor venous access, or reason unidentified. Of the par.. ticipants who had actually placed a PICC line, 46% (12) had placed their first PICC line within one month after attending the training program. In evaluating product selection, 75% (20) of the par.. ticipants placing lines did not use a guidewire during in.. sertion, 57% (15) used the peelable sheaths, and 43% (11) used the breakaway needle t~chnique. The Peri..
JVAD
Volume 1, Number 1
1995
" of·reJ]1olldents
6tJ~'
"., ,
"., , ,,,. , , ,_.,. ,.,., ,
~",
.,
,., ", ,.,.,.___.~
_.~.,
,--_ ,
response Was PICC course necessary?
Reasons:
A: for my own knowledge; no intention at present to placing PICCs B: employer required it; will place and manage PICCs c: employer required it; will only manage PICCs D: seeking employment that requires training in PICC line placement FIGURE 2 While the majority of respondents felt the PIce course was necessary, personal reasons for attending varied.
" ofRespondeNts
] (}O'IJ A. Wed.on't .tartPICC. w.here I u~o,.k
B~'
__ , ,""" " - . _."." '". " ' ~,.,
~"'
_~-~~""
. " " '",."".,. ,-.," " " " " ", ,. -'- -" ", ".", , , , , ,. , ",,- _ ,..
c. D,. Feel comfortable u~ith Bnou~ledlle but
hesitant
Response
FIGURE 3 Reasons for not having inserted PICC lines by six months following participation in the program.
JVAD
Volume 1, Number 1 1995
19
% fJ'fR,e."ondents
100% 90%-100%
80% _., - - ~ - - - - - - - - - - -
60%-90%
40ro-60% 40%
60
40 20%
FIGURE 4 Success rate for PICC line insertion.
vascular Nurse Consultants PICC training progams de' emphasize the use of guidewires, which is thought to be the reason for the low percentage of participants using guidewires. In comparing the three' and six,month sur, vey results, no statistical difference was identified. The information reported reflects the combined survey results.
Conclusion The results of the survey demonstrated that the Plee training program curriculum met the overall needs of the program participants. While the participants did feel that they were adequately prepared to perform this invasive procedure, the low percentage of participants actively inserting Plee lines is of concern. Some of the stumbling blocks encountered by the participants included the following: physicians did not feel comfortable allowing nurses to place central lines, nursing administration was resistant to the procedure,
20
there was a lack of agency policies and procedures in place to guide nursing practice, and the availability of a trained professional for observing and validating competency on placement of initial Plee lines was problematic. That more than 50% of the program participants had not had the opportunity to place a Plee line indicates a clear need to educate other members of the health care team about the benefits and importance that PICC line catheters have in the management of patients in all types of health care settings. Emphasis should be placed on as, sessing patients for candidacy for Plee line placement, which may in turn increase acceptance of this procedure by physicians and administrators. As a result of this survey, Perivascular Nurse Con, sultants has modified the program content by expand, ing the insertion technique component. The success rate of the respondents inserting Plee lines led us to conclude the program content does indeed meet the needs of our participants.
JVAD
Volume 1, Number 1
1995
NAVAN has developed minimum curriculum requirements for PIee train.. ing programs and for the instructor offering the programs. This is an at.. tempt to standardize educational requirements for all practitioners placing PIee lines. Approved programs will have met over 40 curriculum require.. ments. The standardization of PIee line education will ultimately prov.ide the consumer with a higher level of care by assuring that the practitioner has met specific educational requirements. For information on the NAVAN PIee Course Approved Program, please call the NAVAN office at (201) 912..9500.
JVAD
Volume 1, Number 1 1995
21
of the Educational Benefits ofa PICC Insertion Training Program Tess Angeles, BSN Marijane Barbone, RN
Perivascular Nurse Consultants, Inc., has been training nurses on proper insertion techniques and maintenance procedures for Peripherally Inserted Central Catheters (PICC) since 1989. Our mission is to educate nurses to safely, properly, and confidently insert PICC lines. In 1993, we surveyed the nurses who had attended the program to solicit their opinions concerning the appro~ priateness and effectiveness of the program content.
components that needed further explanation or expan~ sion, reasons the participant was not actively inserting PICC lines, number of catheters inserted by the partici~ pant, success rates, and identification of the most com~ mon reason that the participant experienced PICC insertion failure.
Survey Results Survey Method Two hundred participants were surveyed retrospectively at three~ and six~month intervals following attendance at a program. The purpose of the survey was to deter~ mine whether the training program that they had attended was beneficial when actually inserting and managing PICC lines. The survey consisted of 15 multiple~choice ques~ tions (Figure 1). The questions included demographic information, reasons the participants attended the pro~ gram, identification of the course components that were felt to be most helpful, identification of the course
The overall response to the survey was excellent; 17% (69) of the surveys sent were completed and returned. The study demographics indicated that 75% (52) of the participants who responded were employed outside the hospital setting and that 43% (30) worked at a staff nurse level. Of the surveys returned, 95% (66) of the respondents considered the training program helpful and necessary, which validated the need for educational programs. In evaluating the reasons that participants attended the program, the responses were quite varied. thirty~eight percent (26) were required to attend the program by their place of employment in order to place PICC lines, 26% (18) attended the program for infor~
Tess Angeles, BSN, is the vice president of Perivascular Nurse Consultants, Inc., located in Rockledge, Pennsylvania. Ms. Angeles has extensive experience in developing educational programs and materials and in placing PICC lines. Marijane Barbone, RN, is a clinical nurse educator for Perivascular Nurse Consultants, Inc., located in Rockledge, Pennsylvania. Ms. Barbone has had extensive experience training and supervising nurses in the care and management and insertion procedures for PICe lines.
16
JVAD
Volume 1, Number 1 1995
SURVEY QUESTIONS 1. Your place of employment is? a. b. c. d. e.
Hospital setting Clinic..outpatient Homecare Home infusion Other (specify)
2. Your position at your place of employment? a. b. c. d.
Staff Administrator Clinical specialist Other (specify)
3. What was your reason for taking the PICC training program?
a. For my own knowledge. I have no intentions at present to place PICCs b. Because my employer required it. We will be required to place and manage PICCs c. Because my employer required it. We will only be managing PICCs at work d. Because I want to seek employment in the future that requires the course
6. Which part of the course did you find most helpful? a. b. c. d. e. f. g. h.
Video Complications Anatomy Legal aspects Lecture/slides specific to procedure Nursing management Insertion technique Other (specify)
7. Are there any parts of the PICC course you found needed to be expanded upon to help you more in clinical practice? a. b. c. d. e. f. g. h.
Video Complications Anatomy Legal aspects Lecture/slides specific to procedure Nursing management Insertion technique Other (specify)
8. Have you started PICC lines where you work? a. Yes (answer 8a) b. No (answer 8b)
4. Do you feel the course was necessary for you to be able to place a PICC? a. Yes b. No (explain)
5. Did you find the PICC course helpful in your work? a. Very helpful b. Somewhat helpful c. Not at all helpful
8a. If you answered yes to question 8, how much time lapsed between the time you took the PICC course and your first attempt at placing a PICC line? a. b c. d.
Less than one month 1-3 months 4-6 months More than 7 months
8b. If you answered no to question 8, circle all appro.. priate answers. a. b. c. d.
Place of work does not place PICC lines Have not had the opportunity to place PICC lines Do not feel comfortable placing a PICC line Feel comfortable with course knowledge but hesitant to actually perform procedure
FIGURE 1 Survey Questions.
JVAD
Volume 1, Number 1 1995
17
9. On average, how many PICC lines have you started per month? a. b. c. d.
0-5 6-10 11-15 > 16
10. Do you use guidewire to insert PICC lines? a. Yes b. No
11. Which introducer do you prefer? a. Breakaway needle b. Peelable sheath
12. When placing PICC lines, your success rate is approximately? a. 90%-100% b.60%-90% c. 40%-60% d. < 40%
13. What is the most common reason for PICC insertion failure? a. b. c. d. e.
Unable to insert introducer Unable to thread catheter Equipment defect (specify) Uncooperative client Other (specify)
FIGURE 1 (cont'd)
mational purposes only and did not intend to place PICC lines, 25% (17) were required to attend the pro.. gram by their employer in order to manage PICC lines, and 10% (7) attended the program to assist in seeking employment that requires training in PICC insertion and management techniques (Figure 2). The PICC training program was then divided into curriculum components. Forty percent (28) of the par.. ticipants who responded felt that all of the program components were beneficial, 38% (26) felt that the in.. formation and demonstration of insertion techniques were of most value, and 28% (19) of the participants felt that the lecture and slides presented, which were specific to the procedure, provided the most benefit. The participants were asked to identify the compo.. nent of the training curriculum that needed expansion. Twenty.. three percent (16) of the participants indicated that no change to the curriculum was necessary, 17% (12) felt that nursing management needed expansion, 14% (10) of the participants indicated that the insertion tech.. nique component needed further review, and 10% (7) in.. dicated that both the complications of PIce line therapy and anatomy components required further review. Six months following attendance at the program, 62 % (43) of the participants who responded to the sur.. vey had not inserted a PICC line (Figure 3). Fifty.. five
18
percent (38) indicated that they did not have the op'" portunity to insert a PICC line, 43% (30) of the partici.. pants felt comfortable with their knowledge base in PICC lines but were either hesitant at performing the procedure or their employer did not require them to place PICC lines, and 5% (3) did not feel comfortable with the procedure. Of the 38% (26) participants who have inserted PICC lines, 60% (16) were successful with insertion 90% to 100% of the time (Figure 4). Thirty.. seven per.. cent (10) participants indicated that the most common reason for unsuccessful insertion was due to an inability to thread the catheter; 20% (5) were unsuccessful be.. cause the patients were uncooperative; 13% (3) of the participants were unable to insert the introducer; and 30% (8) of the participants indicated they were unsuc.. cessful with insertion due to a variety of reasons, which include product defect, inappropriate patient selection, poor venous access, or reason unidentified. Of the par.. ticipants who had actually placed a PICC line, 46% (12) had placed their first PICC line within one month after attending the training program. In evaluating product selection, 75% (20) of the par.. ticipants placing lines did not use a guidewire during in.. sertion, 57% (15) used the peelable sheaths, and 43% (11) used the breakaway needle t~chnique. The Peri..
JVAD
Volume 1, Number 1
1995
" of·reJ]1olldents
6tJ~'
"., ,
"., , ,,,. , , ,_.,. ,.,., ,
~",
.,
,., ", ,.,.,.___.~
_.~.,
,--_ ,
response Was PICC course necessary?
Reasons:
A: for my own knowledge; no intention at present to placing PICCs B: employer required it; will place and manage PICCs c: employer required it; will only manage PICCs D: seeking employment that requires training in PICC line placement FIGURE 2 While the majority of respondents felt the PIce course was necessary, personal reasons for attending varied.
" ofRespondeNts
] (}O'IJ A. Wed.on't .tartPICC. w.here I u~o,.k
B~'
__ , ,""" " - . _."." '". " ' ~,.,
~"'
_~-~~""
. " " '",."".,. ,-.," " " " " ", ,. -'- -" ", ".", , , , , ,. , ",,- _ ,..
c. D,. Feel comfortable u~ith Bnou~ledlle but
hesitant
Response
FIGURE 3 Reasons for not having inserted PICC lines by six months following participation in the program.
JVAD
Volume 1, Number 1 1995
19
% fJ'fR,e."ondents
100% 90%-100%
80% _., - - ~ - - - - - - - - - - -
60%-90%
40ro-60% 40%
60
40 20%
FIGURE 4 Success rate for PICC line insertion.
vascular Nurse Consultants PICC training progams de' emphasize the use of guidewires, which is thought to be the reason for the low percentage of participants using guidewires. In comparing the three' and six,month sur, vey results, no statistical difference was identified. The information reported reflects the combined survey results.
Conclusion The results of the survey demonstrated that the Plee training program curriculum met the overall needs of the program participants. While the participants did feel that they were adequately prepared to perform this invasive procedure, the low percentage of participants actively inserting Plee lines is of concern. Some of the stumbling blocks encountered by the participants included the following: physicians did not feel comfortable allowing nurses to place central lines, nursing administration was resistant to the procedure,
20
there was a lack of agency policies and procedures in place to guide nursing practice, and the availability of a trained professional for observing and validating competency on placement of initial Plee lines was problematic. That more than 50% of the program participants had not had the opportunity to place a Plee line indicates a clear need to educate other members of the health care team about the benefits and importance that PICC line catheters have in the management of patients in all types of health care settings. Emphasis should be placed on as, sessing patients for candidacy for Plee line placement, which may in turn increase acceptance of this procedure by physicians and administrators. As a result of this survey, Perivascular Nurse Con, sultants has modified the program content by expand, ing the insertion technique component. The success rate of the respondents inserting Plee lines led us to conclude the program content does indeed meet the needs of our participants.
JVAD
Volume 1, Number 1
1995
NAVAN has developed minimum curriculum requirements for PIee train.. ing programs and for the instructor offering the programs. This is an at.. tempt to standardize educational requirements for all practitioners placing PIee lines. Approved programs will have met over 40 curriculum require.. ments. The standardization of PIee line education will ultimately prov.ide the consumer with a higher level of care by assuring that the practitioner has met specific educational requirements. For information on the NAVAN PIee Course Approved Program, please call the NAVAN office at (201) 912..9500.
JVAD
Volume 1, Number 1 1995
21