H03* - The red thread between Piacenza and the Michigan Appropriateness guide for intravenous catheters guidelines

Abstract

Background: On January 2013 our Peripherally Inserted Central Catheters (PICC)-team was born since the care of oncologic patients requires the availability of a reliable long-medium term venous access, due to the particular complexity of the chemotherapy regimens, the frequent need for a nutritional or transfusional support and periodic blood sampling. On June 2013 we launched a learning program for nurses about the management of central venous access. In 2016 the course was opened also to physicians.Material and methods: Starting from the recently published literature, we critically evaluated our activity. For insertion, ultrasound-guidance and the Seldinger technique were used. In PICC positioning an electrocardiogram was performed to verify the correct position of the tip.Results: From January 2013 to December 2015, we have implanted 3268 devices, 1603 PICC (49%) and 1665 midline in 1230 onco-hematologic (37.6%) and 2038 medical patients. Applying a rigorous method for evaluation of indication and management of implanted catheters, our acute and late complications rate is low. Indication for placement were chemotherapy, in- or outpatients nutritional support and antibiotic therapy. Placement failed in two cases and in another two patients there was a primary misplacement. Occlusion occurred in one patient and catheter-related infection in two cases. Catheter-related thrombosis was the most frequent complication, occurring in 19 cases (0.6%). In medical patients the second most frequent complications were accidental removal and malfunction, being reported both in 35 cases (1.7%).Conclusions: The best way to obtain appropriateness is a critical review of own activity, identification of weakness and their prompt correction. In our opinion significant advantage is the presence of a dedicate team besides the use of a portable ultrasound. Ease of PICC placement at a relatively low cost, could lead to unweighted use without careful evaluation of clinical appropriateness. A dedicated team is a way to screen for both contraindication to PICC placement and real appropriateness. In turn, the correct selection of patients will decrease waiting times and likely, hospital stay. Use of ultrasound increases the success rate; furthermore, it allows the bedside placement so reducing costs associated with an interventional suite. So a dedicated team together with the application of a rigorous method of evaluation, is the best way to achieve the appropriateness. Background: On January 2013 our Peripherally Inserted Central Catheters (PICC)-team was born since the care of oncologic patients requires the availability of a reliable long-medium term venous access, due to the particular complexity of the chemotherapy regimens, the frequent need for a nutritional or transfusional support and periodic blood sampling. On June 2013 we launched a learning program for nurses about the management of central venous access. In 2016 the course was opened also to physicians. Material and methods: Starting from the recently published literature, we critically evaluated our activity. For insertion, ultrasound-guidance and the Seldinger technique were used. In PICC positioning an electrocardiogram was performed to verify the correct position of the tip. Results: From January 2013 to December 2015, we have implanted 3268 devices, 1603 PICC (49%) and 1665 midline in 1230 onco-hematologic (37.6%) and 2038 medical patients. Applying a rigorous method for evaluation of indication and management of implanted catheters, our acute and late complications rate is low. Indication for placement were chemotherapy, in- or outpatients nutritional support and antibiotic therapy. Placement failed in two cases and in another two patients there was a primary misplacement. Occlusion occurred in one patient and catheter-related infection in two cases. Catheter-related thrombosis was the most frequent complication, occurring in 19 cases (0.6%). In medical patients the second most frequent complications were accidental removal and malfunction, being reported both in 35 cases (1.7%). Conclusions: The best way to obtain appropriateness is a critical review of own activity, identification of weakness and their prompt correction. In our opinion significant advantage is the presence of a dedicate team besides the use of a portable ultrasound. Ease of PICC placement at a relatively low cost, could lead to unweighted use without careful evaluation of clinical appropriateness. A dedicated team is a way to screen for both contraindication to PICC placement and real appropriateness. In turn, the correct selection of patients will decrease waiting times and likely, hospital stay. Use of ultrasound increases the success rate; furthermore, it allows the bedside placement so reducing costs associated with an interventional suite. So a dedicated team together with the application of a rigorous method of evaluation, is the best way to achieve the appropriateness.