Abstract

Peripherally Inserted Central Catheters (PICC) are essential in modern infusion therapy. We describe a case of a full-term infant with Trisomy 21, congenital cardiac anomalies and sepsis, where the PICC became malpositioned. Noninvasive repositioning strategies were successfully utilized through a team approach, which enabled this unstable infant to complete their therapy course without the undue stress of inserting a new PICC or requiring additional X-Rays or more invasive replacement procedures.

Abstract

Purpose: To explore the level of RNs knowledge of managing vascular access devices (VADs)- peripherally inserted central catheters (PICCs) and midline catheters, and to determine if nurse characteristics are associated with knowledge level.

Background: Education of nursing staff about VAD management can improve quality of care and assure standards of practice are maintained.

Review of Literature: Minimal research is available on nurses' knowledge of managing VAD catheters.

Methods: Nurses working on a colo-rectal unit who frequently manage VADs in a large tertiary-care medical center voluntarily completed one anonymous, validated, 10-item survey of VAD management themes. Analysis included descriptive and correlational statistics.

Results: Of 36 nurses, (97% female, 53% full time), mean VAD knowledge score was 8.1 ± 1.4 (81% mean sum score). Perceived general level of comfort in flushing PICCs (r=.35, P=0.04), using Alteplase with PICCs (r=.36, P=0.03) and changing dressings (r=.38; P=0.03) were associated with higher knowledge scores. Of 10 items, 4 resulted in scores below 80%: how fast a Midline can be used after insertion, first step in managing a PICC upon admission, steps in dealing with a withdrawal occlusion, and steps post interventional radiology PICC insertion; however, nurse characteristics were not associated with scores above or below 80%.

Conclusions: Nurses working in the colo-rectal unit that frequently treat patients with VADs were generally knowledgeable about their management. Perceived nurse comfort in flushing a PICC, using Alteplase, and changing dressings were associated with higher knowledge.

Implications for Practice: Nurses' impressions of comfort with VAD management should be regularly assessed by nurse managers to assure optimal knowledge.

Abstract

Background: Assessing acute care nurse practitioners' (ACNPs) procedural competence for central line insertions encourages best patient outcomes and meets requirements of national credentialing bodies. Implementation of processes to effectively evaluate procedural competence is complicated by the lack of validated, evidenced-based metrics to evaluate ACNP practices.

Purpose: This article identifies validated, evidenced-based metrics to effectively evaluate ACNP procedural competencies.

Methodology: A two-part literature review was performed to 1) determine competency evaluation methods for ACNP skills and to 2) evaluate the use of templates/checklists as a means to encourage compliance with national, evidence-based guidelines. Due to the lack of literature on the use of evaluation tools to assess ACNP procedural competency, literature related to medical training programs and practices was reviewed.

Review of Literature: Fifteen articles were identified that met review criteria related to procedural competency evaluation. Eleven methods for competency evaluation were commonly identified in the literature; however, conclusive evidence indentifying the most effective means of procedural competency evaluation was not found. Seven studies and one expert consensus were identified related to use of standardized forms and templates/checklists to improve national guideline compliance. All studies indicated the use of standardized documentation significantly increased compliance with national guidelines.