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The Impact of Focused Nursing Education on PICC
Occlusion Rates
Dayna Holt, RN, CRNIRady Children’s Hospital, San Diego
BACKGROUND
• Peripherally inserted central catheters (PICC) have become an essential tool in pediatric care.
• At Rady Children’s Hospital 550 to 600 pediatric PICCs are placed annually.
• The small lumen and length of pediatric PICCs requires specialized skill and knowledge in proper care and maintenance.
THE PROBLEM
• Occluded catheters compromise patient care and increase costs.
• Necessary medications and fluids are delayed and can affect patient outcomes or delay discharge.
• Considerable nursing time is required to restore the patency of occluded catheters.
• Occluded PICCs can result in patient dissatisfaction, anxiety, discomfort and stress.
PICO QUESITON
• Population~ Patients with 3F Groshong PICCs.• Intervention~ Focused nursing education
specifically designed to prevent and reduce catheter occlusions.
• Comparison~ Basic nursing orientation and the availability of policy and/or mentors for reference.
• Outcome~ Occlusion rates of 3F Groshong PICCs.
PICO QUESTION
In patients with 3f Groshong PICCs, does implementing a focused nursing education as compared to basic orientation and the availability of policy and procedures decrease catheter occlusion rates?
SYNOPSIS OF EVIDENCE
• Recognizing the causes of PICC occlusion assists the nurse in preventing occlusion occurrences.
• Proper flushing, catheter care and lab sampling technique reduces the occurrence of PICC occlusions.
SYNOPSIS OF EVIDENCE
• Nursing knowledge in the care and flushing of PICCs reduces total catheter occlusions.
• Recognizing and treating partial catheter occlusions prevents the occurrence of total catheter occlusions.
• 3F Groshong PICCs can be utilized effectively for lab sampling with out significant increases in catheter occlusion rates.
METHODS
• A Pre-Test/Post-Test project was designed.
• Convenience sample of all core staff nurses working in Med/Surg at RCHSD
May 2007 to August 2007.
• All data was aggregated and anonymous.
METHODS
• Objective written Test of nursing knowledge.
• Direct observations of nurse’s PICC flushing technique.
• Retrospective chart review to determine catheter occlusion rates.
DATA COLLECTION
• Retrospective chart review December 1, 2006 through February 28, 2007
(N=97)• Direct nursing observations April 16,
2007 through May 9, 2007 days and nights (N=37)
• Written Pre-test followed by educational intervention at Med/Surg mandatory annual education May 2007 (N=101)
DATA COLLECTION
• Written post-test June, 2007 (N=53)4 tests returned in August 2007
• Direct nursing observations August 2007 days and nights (N=39)
• Retrospective Chart Review June 1, 2007 through August 24, 2007 (N=92)
RESULTS
• Nursing knowledge increased – Pre-test mean written test score 0.78– Post-test mean written test score 0.93
(p=<0.0001 equal variances t-test 1 tailed)• Nursing flushing technique improved
– Pre-test mean observation score 0.88– Post-test mean observation score 0.95
(p=0.0045 unequal variances t-test 1 tailed)SSPS statistical software version 14.0
NURSING KNOWLEDGE and PERFORMANCE
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Written Test Observations
Mea
n A
gg
reg
ate
Sco
re Pre
Post
RESULTS
• Pre-test occlusion rates:– M/S 21.11/1000 catheter days (N=55)– Non M/S 18.92/1000 catheter days (N=42)
• Post-test occlusion rates:– M/S 15.49/1000 catheter days (N=50)– Non M/S 24.24/1000 catheter days (N=42)
(Med/Surg p=0.0515 unequal variances t-test 1 tailed)
(Non Med/Surg p=0.45 equal variances t-test 1 tailed)SSPS statistical software version 14.0
3F Groshong PICC Occlusion Rates
0.002.004.006.008.00
10.0012.0014.0016.0018.0020.0022.0024.00
MEDSURG NON MED SURG ALL UNITS
Rat
e pe
r 100
0 ca
thet
er d
ays
PRE
POST
LIMITATIONS
• 50% written post-test return.
• Post-test observations completed over 2 months after focused education.
• Post-test observations completed by simulation rather than actual patient observations.
LIMITATIONS
• Nursing attrition during the study period.
• No provision post intervention for 3F Groshong PICC care only by nurses who participated in the focused education.
CONCLUSIONS
• Focused Nursing Education improved nursing knowledge and flushing technique.
• Focused Nursing Education significantly reduced 3F Groshong PICC occlusions and the associated costs due to PICC occlusions.
RECOMMENDATIONS
• Consider other evidenced-based projects to determine if product selection or cap design has an impact on the rates of catheter occlusion.
• Annually provide PICC specific focused education to all RNs responsible for the care of PICCs.