Original Article
A comprehensive intervention program on the long‑term placement of peripherally inserted central venous catheters ABSTRACT Background: Peripherally inserted central venous catheters (PICCs) have been increasingly utilized in treating patients in intensive care. The purpose of this study is to analyze the related complications and to evaluate effect of a comprehensive intervention on long‑term PICCs. Materials and Methods: We selected 217 and 243 cases before and after comprehensive intervention respectively from the department of radiotherapy in our hospital. Various possible factors affecting PICCs insertions and maintenance were analyzed. A quality control circle was formed for nursing care. The comprehensive intervention was performed both on catheter insertion and post‑PICCs care. Complication rates were compared before and after the intervention. Results: The duration for PICCs was 90 days. In the control group (before intervention), the complications were as follows: Tube feeding difficulties (23.5%), catheter dislodgment (23.5%), infection (17.6%), catheter obstruction (17.6%), puncture failure (5.9%), allergy (5.9%), and pain (5.9%). The incidence of unplanned extubations was 7.8%. The incidence of complications was significantly decreased in the test group (after intervention). Moreover, one episode of catheter obstruction (5.9%) and one episode of allergy (5.9%) were found (P 0.05, Table 1]. Surgery procedures All the cases who received PICCs were the first time underwent radiotherapy and chemotherapy. A 4‑F single lumen catheter, constructed of silicone elastomer (Bard Inc., USA) was inserted blindly into patients of the control group. In contrast, catheters were catheterized ultrasound guided when it is needed into patients in the test group. The catheters were positioned 2 cm below the elbow (avoiding the dominant hand when it is possible). Basilic vein was preferred, otherwise intermedian cubital vein or cephalic vein was chosen. Cases in other departments or hospitals were excluded. Intervention After analyzing data from the control group, we found that risk factors of PICCs‑related complications were controllable. Thus, we set up a quality control circle (QCC) to identify potential issues and teach paramedics the method of PICCs insertion and maintenance. All the paramedics were collected to participate in quality control of PICCs to achieve independent management. Head nurses were commanded to participate in national conferences of intravenous therapy. Moreover, training course for PICC and intravenous therapy conferences were conducted by the hospital for all the nurses. Nurses were demanded to study PICCs insertion and maintenance. Besides, we made sure that the first‑line nurses were skillful to deal with complications of post‑PICCs insertion. Treatments of normal complications are shown in Table 2. Statistical analysis The incidences of complications associated with unplanned extubations between the two groups were compared with SPSS 13.0 (SPSS, USA). Data were analyzed with a χ2 test. P value
A comprehensive intervention program on the long‑term placement of peripherally inserted central venous catheters ABSTRACT Background: Peripherally inserted central venous catheters (PICCs) have been increasingly utilized in treating patients in intensive care. The purpose of this study is to analyze the related complications and to evaluate effect of a comprehensive intervention on long‑term PICCs. Materials and Methods: We selected 217 and 243 cases before and after comprehensive intervention respectively from the department of radiotherapy in our hospital. Various possible factors affecting PICCs insertions and maintenance were analyzed. A quality control circle was formed for nursing care. The comprehensive intervention was performed both on catheter insertion and post‑PICCs care. Complication rates were compared before and after the intervention. Results: The duration for PICCs was 90 days. In the control group (before intervention), the complications were as follows: Tube feeding difficulties (23.5%), catheter dislodgment (23.5%), infection (17.6%), catheter obstruction (17.6%), puncture failure (5.9%), allergy (5.9%), and pain (5.9%). The incidence of unplanned extubations was 7.8%. The incidence of complications was significantly decreased in the test group (after intervention). Moreover, one episode of catheter obstruction (5.9%) and one episode of allergy (5.9%) were found (P 0.05, Table 1]. Surgery procedures All the cases who received PICCs were the first time underwent radiotherapy and chemotherapy. A 4‑F single lumen catheter, constructed of silicone elastomer (Bard Inc., USA) was inserted blindly into patients of the control group. In contrast, catheters were catheterized ultrasound guided when it is needed into patients in the test group. The catheters were positioned 2 cm below the elbow (avoiding the dominant hand when it is possible). Basilic vein was preferred, otherwise intermedian cubital vein or cephalic vein was chosen. Cases in other departments or hospitals were excluded. Intervention After analyzing data from the control group, we found that risk factors of PICCs‑related complications were controllable. Thus, we set up a quality control circle (QCC) to identify potential issues and teach paramedics the method of PICCs insertion and maintenance. All the paramedics were collected to participate in quality control of PICCs to achieve independent management. Head nurses were commanded to participate in national conferences of intravenous therapy. Moreover, training course for PICC and intravenous therapy conferences were conducted by the hospital for all the nurses. Nurses were demanded to study PICCs insertion and maintenance. Besides, we made sure that the first‑line nurses were skillful to deal with complications of post‑PICCs insertion. Treatments of normal complications are shown in Table 2. Statistical analysis The incidences of complications associated with unplanned extubations between the two groups were compared with SPSS 13.0 (SPSS, USA). Data were analyzed with a χ2 test. P value
