Peripherally inserted central catheters (PICC): Experience, practice, knowledge, and opinions

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Intravenous literature: Chopra, V., Kuhn, L., Coffey, C.E.Jr., Salameh, M., Barron, J., Krein, S., Flanders, S.A. and Saint, S. (2013) Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: A michigan survey. Journal of Hospital Medicine. March 22nd. [Epub ahead of print].

Abstract:

BACKGROUND: Peripherally inserted central catheters (PICCs) are commonly inserted during hospitalization for a variety of clinical indications.

OBJECTIVE: To understand hospitalist experience, practice, knowledge, and opinions as they relate to PICCs.

DESIGN AND SETTING: Web-based survey of hospitalists in 5 healthcare systems (representing a total of 10 hospitals) across Michigan.

RESULTS: The overall response rate was 63% (227 hospitalists received invitations; 144 responded). Compared with central venous catheters, hospitalists felt that PICCs were safer to insert (81%) and preferred by patients (74%). Although 84% of respondents reported that placing a PICC solely to obtain venous access was appropriate, 47% also indicated that 10%-25% of PICCs inserted in their hospitals might represent inappropriate placement. Hospitalist knowledge regarding PICC-related venous thromboembolism was poor, with only 4% recognizing that PICC-tip verification was performed principally to prevent thrombosis. Furthermore, several potential practice-related concerns were identified: one-third of hospitalists indicated that they never examine PICCs for externally evident problems, such as exit-site infection; 48% responded that once inserted, they did not remove PICCs until a patient was ready for discharge; and 51% admitted that, at least once, they had “forgotten” that their patient had a PICC.

CONCLUSIONS: Hospitalist experiences, practice, opinions, and knowledge related to PICCs appear to be variable. Because PICC use is growing and is often associated with complications, examining the impact of such variation is necessary. Hospitals and health systems should consider developing and implementing mechanisms to monitor PICC use and adverse events.

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