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Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study
  1. Sarah L Krein1,2,
  2. Molly Harrod1,
  3. Lauren E Weston1,
  4. Brittani R Garlick1,
  5. Martha Quinn3,
  6. Kathlyn E Fletcher4,5,
  7. Vineet Chopra1,6
  1. 1Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  3. 3School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  4. 4Internal Medicine, Clement J. Zablocki VAMC, Milwaukee, Wisconsin, USA
  5. 5Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  6. 6Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Sarah L Krein, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; skrein{at}umich.edu

Abstract

Background Peripherally inserted central catheters (PICCs) provide reliable intravenous access for delivery of parenteral therapy. Yet, little is known about PICC care practices or how they vary across hospitals. We compared PICC-related processes across hospitals with different insertion delivery models.

Methods We used a descriptive qualitative methodology and a naturalist philosophy, with site visits to conduct semistructured interviews completed between August 2018 and January 2019. Study sites included five Veterans Affairs Medical Centres, two with vascular access teams (VATs), two with PICC insertion primarily by interventional radiology (IR) and one without on-site PICC insertion capability. Interview participants were healthcare personnel (n=56), including physicians, bedside and vascular access nurses, and IR clinicians. Data collection focused on four PICC domains: use and decision-making process, insertion, in-hospital management and patient discharge education. We used rapid analysis and a summary matrix to compare practices across sites within each domain.

Results Our findings highlight the benefits of dedicated VATs across all PICC-related process domains, including implementation of criteria to guide PICC placement decisions, timely PICC insertion, more robust management practices and well-defined patient discharge education. We also found areas with potential for improvement, such as clinician awareness of PICC appropriateness criteria and alternative devices, deployment of VATs and patient discharge education.

Conclusion Vascular access nurses play critical roles in all aspects of PICC-related care. There is variation in PICC decision-making, care and maintenance, and patient education across hospitals. Quality and safety improvement opportunities to reduce this variation are highlighted.

  • nosocomial infections
  • nurses
  • patient safety
  • qualitative research

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Footnotes

  • Twitter @Sarahlkrein, @vineet_chopra

  • Contributors SLK and VC: study concept and design, conduct interviews, analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content. MH: study design, conduct interviews, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. MQ and KEF: conduct interviews, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content.LEW and BRG: analysis and interpretation of data, and critical revision of the manuscript for important intellectual content.

  • Funding This study was funded by US Department of Veterans Affairs (HSR&D IIR 15-313 and RCS 11-222). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Department of Veterans Affairs or the US Federal Government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the VA Ann Arbor Healthcare System institutional review board (IRB-2017–1038), with written documentation of informed consent obtained from interview participants by a member of the interview team.

  • Data availability statement Data are available upon reasonable request. Deidentified, anonymised data that support the findings of this study will be made available by the corresponding author, SLK, on reasonable request and with a letter of agreement.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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