Peripherally Inserted Central Catheter Use in Skilled Nursing Facilities: A Pilot Study

Abstract

OBJECTIVES To describe patterns of use, care practices, and outcomes related to peripherally inserted central catheter (PICC) use in skilled nursing facilities (SNFs). DESIGN Prospective cohort study. SETTING Two community SNFs. PARTICIPANTS Adult SNF residents with PICCs (N = 56). MEASUREMENTS Information on indication for PICC use, device characteristics (e.g., lumens, gauge), and participant data (comorbidities, medications) were obtained from medical records. Care practices (e.g., frequency of flushing, dressing care) and problems related to PICCs were recorded. Major (central line–associated bloodstream infection, venous thromboembolism, catheter dislodgement) and minor (migration, dressing disruption, lumen occlusion, exit site infection) complications and process measures (flushing of PICC, assessment of necessity) were recorded. Bivariate analyses with t-tests, chi-square tests, or Fischer exact tests were used for continuous and categorical data. RESULTS Participants were enrolled from two SNFs. The most common indication for PICC use was intravenous antibiotic delivery. The average PICC dwell time was 43 days, and most devices were single-lumen PICCs. Major and minor complications were common and occurred in 11 (20%) and 18 (32%) participants, respectively. Occlusion (23%, n = 13), accidental dislodgement (12%, n = 7), and dressing disruption (11%, n = 6) were the commonest complications observed. Documentation regarding catheter care practices occurred in 41% of cases. CONCLUSION Quality improvement efforts that seek to benchmark practice, identify gaps, and institute efforts to improve PICC care and practice in SNFs appear necessary.

Variation in prevalence and patterns of peripherally inserted central catheter use in adults hospitalized with pneumonia

“…These observations suggest that PICC use may reflect underlying severity of illness, as advanced care such as ventilator support was often associated with PICC use. Additionally, discharge to a skilled nursing facility was frequently associated with PICC placement, a finding consistent with a recent study evaluating the use of PICCs in these settings . However, a substantial proportion of PICC use remained unexplained by available patient or hospital factors.…”

“…Additionally, discharge to a skilled nursing facility was frequently associated with PICC placement, a finding consistent with a recent study evaluating the use of PICCs in these settings. 32 However, a substantial proportion of PICC use remained unexplained by available patient or hospital factors. Although our study was not specifically designed to examine this question, a possible reason may relate to unmeasured institutional factors that influence the propensity to use a PICC, recently termed as "PICC culture."…”

Peripheral Intravenous Catheter (PIVC) Related Local Complications among Patients in KFCH-Jizan

“…It is used to save lives of patients by different means, however, in some cases became an additional risk. Risk includes local complications related PIVC such as phlebitis [1]. Phlebitis is the inflammation of the veins which may be due to mechanical, chemical, or infectious causes [2].…”

Challenges for Nurses Caring for Individuals with Peripherally Inserted Central Catheters in Skilled Nursing Facilities

“…[7][8][9] A study evaluating use of PICCs in SNFs was recently conducted, providing the unique opportunity to explore the perceptions of residents and providers caring for these devices. 10 An exploratory qualitative study was conducted to understand resident experiences with having a PICC and problems that nurses encountered with device care, to evaluate resources available to care for individuals with PICCs, and to examine the training and education nurses receive to manage these devices.…”