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Tracking PICC Data
Results: Only two pilot randomized controlled trials were suitable for inclusion. These studied 123/195 surgical patients with arterial catheters, with the same four interventions: control standard polyurethane, integrated device TegadermÔ Advanced, the securement device StatLockÒ and tissue adhesive HistoacrylÒ. All methods were superior to control standard care polyurethane and the processes were feasible. Incidence of catheter failure overall was: occlusion 12%, dislodgement 2% and thrombosis 1%. Pooled intervention group failure was 27/241 (11%). Pilot economic analyses indicated the newer products were more cost-effective, and the most economical way for further testing was a large fourarm trial. Discussion: Both trials had robust methodology. The observed effect sizes supported the necessity for future research. Overall 11% catheter failure rate was unacceptably high. Limitations: The pilot trials were intentionally underpowered to test statistical difference. Conclusions: Both trials showed standard care dressings were inadequate. Thus, we plan a future multicenter randomized trial which will definitively test these dressing/securement interventions to prevent arterial catheter failure, with the intention to inform future practice.
Tracking PICC Data Sarah Robinson Background: An understanding of PICC complications, dwell time, and insertion data was difficult to obtain without extensive chart audits. Without this information, tracking of complication data was not conducted. Purpose: The purpose was to create a database that easily compiled data for every PICC insert in the facility. This data can then be formatted into monthly reports. Project Description: An Access database was created by the writer’s facilities IT department. The PICC line information for each PICC placed is entered into the PICC QA database during insertion, any pertinent information during the length of stay is also entered, and the removal date and reason is entered when the line is removed. The information is than compiled into monthly reports. Results: The database began in September 2008. It now contains over 7994 PICC lines information. Each patient’s PICC information can be sorted by patient medical record number allowing the inserting clinician to look up the patient’s information prior to insert to access any PICC history prior to insert attempt. Implications: The data gained from the database has resulted in process changes for the facility, including the implementation of a chlorehexidine impregnated disc at the insert site, the use of chlorehexidine impregnated catheters for the prevention of deep vein thrombosis, and the elimination of routine chest xrays by the implementation of a tip locating device. Conclusion: The PICC QA Database has improved the care of the patients who receive a PICC at the writer’s facility. The information gained from the database has resulted in process changes and an understanding of complication issues.
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A Nurse Driven Strategy to Significantly Decrease PICC Insertion Delays Through the Design and Execution of a Pre-PICC Procedure Process Kristine Sadlek Background: The PICC team places approximately 200 PICC lines per month. The mean time from room arrival to start of procedure was 15 minutes. The previous process was fragmented with subsequent delays. The delays encountered when entering the patient’s room resulted in an average of 50 hours per month. Purpose: By decreasing the number of delays the PICC team encounters for each patient there was an opportunity to place more lines, decrease length of stay (LOS), increase patient throughput, decrease ED boarding, and increase patient and nurse satisfaction. Project or Case Description: The team developed and implemented a Pre-PICC Procedure Process (P4) tool for the nursing staff. Four main components reminded them to assess for patient needs and prepare the patient and room adequately for the PICC team. The process included the PICC team calling ahead to the bedside nurse with an approximate time of arrival for the PICC line placement so prep and education could be initiated. A second call to the nurse was made by the PICC team about 20 minutes prior to arrival to the patient’s room. Results: Total procedure delays decreased from 15 to nine minutes per case. Total PICC placement prep time delays decreased from 50 hours to 30 hours per month. Implications: Measurable patient outcomes included decreased LOS, increased patient throughput, and decreased ED boarding. Additional benefits included increased patient satisfaction due to improved communication amongst the interdisciplinary health care team; increased overall nurse satisfaction with teamwork; increased the number of PICC lines placed per day; decreased delays in patient discharge times. Conclusions: The P4 check list items allow the bedside nurse to adequately prepare the patient, family and the room for the procedure. In addition to improving the patient’s plan of care the P4 improved operational flow resulting in a positive ripple effect for the entire organization. The P4 strategy may be replicated in other organizations to yield similar positive outcomes.
A Prospective Study of Placement and Confirmation of Peripheral Inserted Central Catheters (PICC) Tip Position Using a New Tracking and Electrographic Method Herve Rosay Background/Purpose: Atrio-cava junction is the best position for central venous catheters (CVC). Fluoroscopy is still the reference to place PICC in France. The endocavitary ECG
2015
Tracking PICC Data Sarah Robinson Background: An understanding of PICC complications, dwell time, and insertion data was difficult to obtain without extensive chart audits. Without this information, tracking of complication data was not conducted. Purpose: The purpose was to create a database that easily compiled data for every PICC insert in the facility. This data can then be formatted into monthly reports. Project Description: An Access database was created by the writer’s facilities IT department. The PICC line information for each PICC placed is entered into the PICC QA database during insertion, any pertinent information during the length of stay is also entered, and the removal date and reason is entered when the line is removed. The information is than compiled into monthly reports. Results: The database began in September 2008. It now contains over 7994 PICC lines information. Each patient’s PICC information can be sorted by patient medical record number allowing the inserting clinician to look up the patient’s information prior to insert to access any PICC history prior to insert attempt. Implications: The data gained from the database has resulted in process changes for the facility, including the implementation of a chlorehexidine impregnated disc at the insert site, the use of chlorehexidine impregnated catheters for the prevention of deep vein thrombosis, and the elimination of routine chest xrays by the implementation of a tip locating device. Conclusion: The PICC QA Database has improved the care of the patients who receive a PICC at the writer’s facility. The information gained from the database has resulted in process changes and an understanding of complication issues.
244
j
JAVA
j
Vol 20 No 4
j
A Nurse Driven Strategy to Significantly Decrease PICC Insertion Delays Through the Design and Execution of a Pre-PICC Procedure Process Kristine Sadlek Background: The PICC team places approximately 200 PICC lines per month. The mean time from room arrival to start of procedure was 15 minutes. The previous process was fragmented with subsequent delays. The delays encountered when entering the patient’s room resulted in an average of 50 hours per month. Purpose: By decreasing the number of delays the PICC team encounters for each patient there was an opportunity to place more lines, decrease length of stay (LOS), increase patient throughput, decrease ED boarding, and increase patient and nurse satisfaction. Project or Case Description: The team developed and implemented a Pre-PICC Procedure Process (P4) tool for the nursing staff. Four main components reminded them to assess for patient needs and prepare the patient and room adequately for the PICC team. The process included the PICC team calling ahead to the bedside nurse with an approximate time of arrival for the PICC line placement so prep and education could be initiated. A second call to the nurse was made by the PICC team about 20 minutes prior to arrival to the patient’s room. Results: Total procedure delays decreased from 15 to nine minutes per case. Total PICC placement prep time delays decreased from 50 hours to 30 hours per month. Implications: Measurable patient outcomes included decreased LOS, increased patient throughput, and decreased ED boarding. Additional benefits included increased patient satisfaction due to improved communication amongst the interdisciplinary health care team; increased overall nurse satisfaction with teamwork; increased the number of PICC lines placed per day; decreased delays in patient discharge times. Conclusions: The P4 check list items allow the bedside nurse to adequately prepare the patient, family and the room for the procedure. In addition to improving the patient’s plan of care the P4 improved operational flow resulting in a positive ripple effect for the entire organization. The P4 strategy may be replicated in other organizations to yield similar positive outcomes.
A Prospective Study of Placement and Confirmation of Peripheral Inserted Central Catheters (PICC) Tip Position Using a New Tracking and Electrographic Method Herve Rosay Background/Purpose: Atrio-cava junction is the best position for central venous catheters (CVC). Fluoroscopy is still the reference to place PICC in France. The endocavitary ECG
2015