PICC care standards in skilled nursing facilities

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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.

Reference:

Chopra, V., Montoya, A., Joshi, D, Becker, C., Brant, A., McGuirk, H., Clark, J., Harrod, M., Kuhn, L. and Mody, L. (2015) Peripherally Inserted Central Catheter Use in Skilled Nursing Facilities: A Pilot Study. Journal of the American Geriatrics Society. August 27th. [epub ahead of print].

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