Peripherally inserted central catheters (PICCs) play a key role in providing venous access for medication and fluids, laboratory testing, and hemodynamic monitoring. Despite standardization of insertion practices, little is known about nursing knowledge and practice related to maintaining and caring for PICCs in hospitalized patients. We set out to explore bedside registered nurse (RN) (1) practices and information sources related to PICC care (2) comfort level and concerns, and (3) knowledge gaps related to PICC maintenance. In addition, we were interested in understanding whether these outcomes varied by medical or surgical nurses.
A survey‐based study of RNs in 6 adult medical/surgical units at a quaternary medical center was conducted. Descriptive statistics were used to identify and quantify variations in reported practice, concerns, and knowledge regarding PICC care.
163 of 166 RNs completed the survey (98% response rate). Participants had a mean of 8 years clinical experience (range 1‐30) and represented day, evening, and night shifts. With respect to information sources, only 1/3 of nurses stated that they had accessed the comprehensive institutional policy on PICC care, while 41.9% reported that they relied on discussions with PICC nurses to obtain this information. Significant variations were reported in PICC maintenance practices. For instance, only 29.4% of surveyed RNs stated that they flushed all PICC lumens daily regardless of whether or not there was an ongoing infusion. Approach and frequency of dressing change also varied significantly, with 15.4% of respondents stating that they change the dressing every week compared to 34.4% who did so only if the dressing was wet, loose, or soiled. However, more commonly (42.9%) nurses stated that they deferred all dressing and site care to the PICC team. Although 62% of those surveyed reported feeling comfortable caring for PICCs, restoring patency to an occluded PICC and initiating interventions for PICC complications were cited as specific areas of concern. In particular, respondents were most concerned about catheter/bloodstream infections (66.3%) and thrombosis (31.9%). 32.5% of all respondents stated they needed to learn more about PICC care while 23.5% felt that appropriateness of PICC use in hospitalized patients remained an important knowledge gap. No significant differences were noted between responses from medical or surgical nurses, except for the fact that surgical nurses were more likely to report appropriate dressing changes than nurses on a medical unit (42.2% vs. 22.5%, P<0.01). In addition, only 2.4% of surgical nurses felt that up to half of all PICCs could be avoided, compared to 10% of medical nurses (P=0.05).
Medical and surgical nurses at one facility reported significant knowledge gaps and variation related to management of PICCs. As post insertion care is integral to safe PICC outcomes, studies to further evaluate this variability in other hospitals combined with strategies to promote evidence‐based practices are necessary. Concerns and variability identified in this survey with respect to PICC care and appropriateness are important starting points for this research agenda.
To cite this abstract:Teo H, Nichani S, Kuhn L, Krein S, Chopra V. Nursing Practice, Concerns and Knowledge Gaps Related to Peripherally Inserted Central Catheters: A Survey‐Based Study. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 84. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/nursing-practice-concerns-and-knowledge-gaps-related-to-peripherally-inserted-central-catheters-a-surveybased-study/. Accessed July 17, 2019.