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Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice
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Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice
An example of evidence based process
Lucia Garate EcheniqueNursing Research Supervisor
BackgroundINCORPORATING TECHNOLOGY INTO HOSPITAL
CLINICAL PRACTICE
REQUEST TO PURCHASING COMMITTEE
ACCEPTANCE REJECTION
Background• Incorporating technology into hospital clinical practice
PURCHASINGCOMMITTEE
ACHIEVEMENT OF MANAGEMENT OBJETIVES
PREVIOUSCONCESSIONS
PREVIOUSPURCHASES/ INVESTMENTS
IMPRESSIONS OFCLINICAL BENEFIT
PROFESSIONALATTITUD
FEARS ECONOMICAL RESURCES
PATIENTPREFERENCES
Background
Long-term: Third generation polyurethane or silicone
Inserted in upper arms: Peripherally inserted
End of catheter in superior cava vein
Can be inserted at bed-side by trained nurses
PICC : Peripherally Inserted Central Catheter
Background
LIFE CYCLE OF HEALTH TECHNOLOGY
EMERGING TECHNOLOGIES
Background
“Technologies have occasionally had rapid development and dissemination in the health care system (…) influenced by factors such as social pressure, commercial pressure, the enthusiasm of health professionals, lack of barriers to their implementation or the existence of technical difficulties for evaluation. This fact has led sometimes to further demonstrate its ineffectiveness and even harm.”
The EARLY ASSESSMENT OF EMERGING TECHNOLOGIES aims:
1. To identify characteristics in terms of improvement in clinical practice, adverse effects, ethical and economic aspects.
2. To Help in the decision-making 3. To Prevent the undesirable consequences of the introduction
of new health technologies.
Objective
• To describe the evidence-based incorporation of PICC for cancer patients in the Araba University Hospital.
Methods
1) Bibliographic review: January 2010-June 2010
2) Nurses education/ training
3) Protocol desining: prior, insertion, postinsertion, education for patients.
4) Database monitoring: success in placement, incidences, duration, reasons for withdrawal, complications. June 2011.
5) Request to the Purchasing Commitee.
Acceptance: PICC (October 2010) & Ultrasound (Febreary 2011).
6) Observational prospective study
PATIENTS INTERVENTIONS COMPARISONS OUTCOME
Cancer Patient
PICC PLACEMENT
CVCImplantable
PortsPeripheral Cathethers
DURATIONCOMPLICATIONSATISFACTION
MESH/ EMTREE
UptoDATETripdatabase
DARECochrane
EMB Reviews
MEDLINEEMBASECINAHL
130 documentsretrieved
Methods
Diameter: 0,4 - 1 cm.
Diameter: 0,4 - 1 cm.
Depth: 0.5-1 cmDepth: 0.5-1 cm
Microseldinger Technique Ultrasound
Evidence BasedPROTOCOL DEVELOPMENT
PREINSERTION
INSERTION
POST INSERTION
MAINTENANCE
PATIENT EDUCATION
Observational Prospective Study
Methods
Methods
Request to the Purchasing Committee
ResultsN=218 Inserted in Araba University Hospital
95,8% to Cancer Patients
0
5
10
15
20
25
Results
INSERTION SUCCESS RATE 96.3% (CI 95%: 92.9 – 98.1)
100
50
100
75
100
5056
91
66
80
90
100
84
100
54
9295 94
100100
0
10
20
30
40
50
60
70
80
90
100
jun-1
0jul
-10
Aug-1
0
sep-
10
oct-1
0
nov-
10
Dec-1
0
Jan-
11
feb-
11
mar
-11
Apr-1
1
may
-11
jun-1
1jul
-11
aug-
11
sep-
11
oct-1
1
nov-
11
dec-
11
jan-1
1
%
NWithdrawed Catheters
90
Mean 147.6
Median 99.5
Stand. Dev. 122,.2
Mín. 9,0
Max. 533.0
Percentiles
25 50,0
50 99.5
75 235.5
Results
0,40
0,24
0,160,08 0,08
TOTAL CATHETER DAYS = 24.031
Results
0,66
0,29
0,20 0,2
0,04
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
Co
mp
lica
tio
n/1
,00
0
Ca
the
ter-
Da
ys
TOTAL: 24,031 Catheter Days
Nº of Adverse Effects: 49
Adverse Effect 95% CI: 1.5-2.7 /1,000 Catheter-Days
0,40
0,24
0,160,08 0,08
Results
112
214
29
18
336308
0
280
0
50
100
150
200
250
300
350
400
20082009
20102011
2012
Implanted Port
Drum
CVC
PICC
CENTRAL VENOUS DEVICES CONSUMPTION
(2008-2012)
IMPLANTED PORT PICC
247 € 95€
Operating Theatre
90 min
Hospitalisation Room
60 min
1 Surgeon
1 Nurse
1 Nurse
1 Auxiliary Nursign Care
Discussion
• PICC are an example of how technology can be incorporated into hospital practice based on evidence criteria.
• However, the vast amount of technology hospitals manage and the effort needed to search, read, and create evidence constitute important difficulties to be faced in the technology incorporation processes.
• In hospital routine this proccess may be insufficiently protected. The creation of hospital based technology evaluation committes could support the proccess of incorporation technology following evidence-based criteria.
Implications for Practice
• PICC is now an available, safe, and cost-effective central
venous device in our hospital, preferable to other devices for
cancer patients.
• When the process of adquiring technology in hospitals involves
practicioners, researchers, material resources responsibles,
and managers it is easier to incorporate technology which is
relevant and appropriate, in both scientific and economical terms,
to clinical practice.
