Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice

Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice

An example of evidence based process

Lucia Garate EcheniqueNursing Research Supervisor

lucia.garateechenique@osakidetza.net

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.

Thank you

Lucia Garate EcheniqueNursing Research Supervisor

lucia.garateechenique@osakidetza.net

Eskerrik Asko

Gracias