OBJECTIVE: The primary aim of this project is to reduce the incidence of 3 Fr. Groshong™ PICC occlusions through focused nursing education. BACKGROUND: The use of Peripherally Inserted Central Catheters (PICC) has become an essential tool in the care of pediatric patients. The small lumen and long length of PICCs requires specialized skill and knowledge in proper care, maintenance and flushing in order to prevent catheter occlusion and other complications. Occluded catheters compromise patient care and increase costs. Reducing the incidence of catheter occlusion, will have a significant impact on the quality of patient care; patient, family and nursing satisfaction, patient outcomes, and costs. METHODS: A pre-test/post-test design using a convenience sample of all the core staff nurses working on the medical/surgical unit at a Southern California Children's Hospital was utilized. Objective measures included a written assessment of nursing knowledge, direct observations of nurses' flushing technique, and retrospective chart review to determine the rate of total catheter occlusion. RESULTS: Mean written test scores improved from 0.78 to 0.93 (p=0.00) Mean observation scores improved from 0.88 to 0.95, (p=0.004). The pre-test occlusion rate was 21.11/1000 catheter days. The post test occlusion rate was 15.49/1000 catheter days (p=0.057). CONCLUSION: Focused nursing education contributed to reducing 3F Groshong™ PICC occlusions and the associated costs due to PICC occlusions.
Background: Although it is common for central line catheters to develop a thrombotic occlusion, pediatric patients are at especially high risk of occlusion due to smaller vessels, smaller-gauge catheters, and slower rates of infusion. Mitigating catheter occlusions is costly, requiring tissue plasminogen activator, supplies, and nursing time. Our facility tested a novel neutral displacement needle-free valve designed to reduce occlusion.
Methodology: The organization determined a baseline occlusion rate for Hickman/Broviac catheters, in our 38-bed inpatient hematology/oncology department and our outpatient hematology/oncology clinic from August 2010 through October 2010. In 2011, a premarket test of the Neutron device (ICU Medical, San Clemente, CA) was conducted on the units. Based on the positive trial results, it was decided to implement the device housewide in December 2012.
Results: A comparison of baseline central line complete occlusion rates from August to October 2010 with Neutron trial data from July to October 2011. This pilot project demonstrated a 74.3% reduction (from a rate of 3.82 to a rate of 0.98) in all hematology/oncology department Hickman and Broviac complete catheter occlusions. Subsequently, comparing 5 months of housewide occlusion data from June through October 2012 to 2013, complete occlusions fell by 32.1% (from a rate of 1.56 to a rate of 1.06).
Conclusions: The use of the Neutron needle-free catheter patency device was associated with a reduction in complete occlusions. The corresponding reduction in treatment delays, nursing time spent managing occluded catheters, and fewer needlesticks to patients likely translates to financial benefit for the organization and improved patient and family satisfaction.
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