Abstract

To date, there is no published, psychometrically validated, short peripheral intravenous catheter (PIVC) insertion skills checklist. Creating a valid, reliable, and generalizable checklist to measure PIVC skill is a key step in assessing baseline competence and skill mastery. Based on recognized standards and best practices, the PIVC Insertion Skills Checklist was developed to measure all the steps necessary for a best practice PIVC insertion. This includes the entire process from reading the prescriber's orders to documentation and, if the first attempt is unsuccessful, a second attempt option. Content validity was established using 3 infusion therapy experts. Evidence in support of response process validity is described. The PIVC Insertion Skills Checklist was used by 8 trained raters to assess the PIVC insertion skills, in a simulated environment, of 63 practicing clinicians working on medical and surgical units in a US teaching hospital. Internal consistency of the PIVC Insertion Skills Checklist was α = 0.84. Individual item intraclass correlation coefficients (ICCs) between rater and gold standard observations ranged from − 0.01 to 1.00 and total score ICC was 0.99 (95% confidence interval, 0.99–0.99). The current study offers validity and reliability evidence to support the use of the PIVC Insertion Skills Checklist to measure PIVC insertion skill of clinicians in a simulated environment.

Abstract

Background: Patients in our health region received 1 of 2 different arm ports, totally implanted venous access devices (TIVADs), for the management of their malignancies. One of the ports was a nonpower-injectable design and the other was power-injectable. Infusion nurses most commonly access TIVADs in our health region. It was our goal to evaluate infusion nursing access events for these 2 different TIVADs to determine whether nurses experienced any practical, or functional, differences based on port design.

Methods: For this quality assurance project a locally designed, paper-based, questionnaire was developed and administered. Infusion nurses completed the questionnaire after they had accessed an arm TIVAD for intravenous chemotherapy. Sequential access events were tracked for 2 months.

Results: There were no statistically significant differences in the responses related to the 2 different TIVAD designs. Identifying the type of implanted TIVAD for each access event in the study group provided some challenges for the infusion nurses. Eighteen nonpower-injectable ports were erroneously identified as power-injectable.

Conclusions: The results illustrate that our local cancer center infusion nurses were a very experienced group who have been able to adapt to the 2 different arm TIVAD designs. There was no statistically different access event parameters for the 2 different port designs. Additional end-user education may be warranted to improve port design identification.

Abstract

Our hospital, a 220-bed, level-1 trauma center, sees an increase in patients with acute respiratory distress syndrome (ARDS) during the winter months. To maximize an ARDS patient's lung capacity and improve mortality rates (which can be as high as 40%), it is common for a critically ill patient to remain intubated in a prone position until ventilation/perfusion rates improve. When central line access is needed, but the patient cannot tolerate staying supine for the procedure, it was hypothesized that a peripherally inserted central catheter (PICC) could be placed with the patient prone. Six patients received PICCs with a 100% success rate. The ability to place a PICC in any critically ill, prone patient can expedite the administration of fluids and drugs by the critical care team and assist them in providing optimal care.

Abstract

Background: Advances in medical technology have allowed pediatric patients to be discharged home with complex devices, including central venous catheters (CVCs). For these patients to be safely discharged, families require training to care for these catheters. At a large children's hospital, extensive family education and training for CVCs was already established. However, community caregivers were not receiving the same training. In an effort to target these caregivers, an education program was designed and implemented in 2011.

Methods: The program was originally designed and implemented by nurses on a gastroenterology unit and has expanded to include instructors from the vascular access team, hematology/oncology department, and pulmonary department. All community nurses providing care for pediatric patients in the region are welcome to attend the free class with education hours offered. The class is structured with lecture time and skills practice through simulation.

Results: Since the program began in 2011, 34 classes have been offered and 305 nurses have attended from multiple home health companies and school districts in the region. Community-acquired central line-associated bloodstream infection (CLABSI) rates for the pediatric gastroenterology and oncology patient populations have decreased significantly since the class began.

Conclusions: An education program targeting nurses in the community who care for complex patients with CVCs can decrease community-acquired infection rates and complications. This program can be designed and tailored for multiple patient populations with varying complexities and medical devices.

Abstract

Health care is becoming increasingly complex. Introduction of new technologies can be overwhelming and complex. The following article outlines the use of a change process theoretical framework to plan, implement, and sustain successful outcomes with integration of electrocardiogram-placed peripherally inserted central catheters at a major metropolitan medical teaching facility.

Abstract

Background: To assess the technical success of ultrasound (US)-guided peripherally inserted central catheter (PICC) placement at a large academic medical center and evaluate the direct and indirect costs associated with malpositioned catheters.

Methods: This retrospective chart review consisted of 250 consecutive inpatients and 150 consecutive outpatients (N = 400, aged 58 ± 17 years, 225 men and 175women) who underwent US-guided PICC placement at a single center. Repositioning rates were compared between high-complexity (inpatient) and low-complexity (outpatient) groups using a χ² test and phi coefficient. Initial and final catheter tip position was assessed by radiography. Direct costs of repositioning were estimated using Medicare reimbursement rates. Indirect costs, including additional staff time, imaging, and delays in treatment, were assessed via a survey of PICC nurses and chart reviews.

Results: Initial PICC placement resulted in an optimal tip position in 34% of patients and an optimal or acceptable position in 84% of patients. Repositioning rates were significantly higher for inpatients with a low to moderate association between inpatient PICC placement and the need for repositioning (χ² = 9.603, P = .002; σ = 0.155, P = .002). In total, 77 catheters required repositioning, costing on average an additional $186.03 and 50 minutes of staff time per catheter as well as delaying catheter use in 23 patients for at least 24 hours.

Conclusions: PICC malpositioning is a significant source of inefficiency, especially for inpatient services, that should be addressed to reduce expenditures and maximize patients' perceptions of quality health care.