Introduction
PICCs are employed to administrate substances directly into the major vessels; however, their use is associated with a number of complications, some of which may be related to the techniques of PICC insertion. Therefore, it is crucial to identify the trends related to the utilization of PICCs and consider their possible influence on insertion procedures. In this paper, the data pertaining to the problem was collected from articles studying the issue in settings similar to the Kendall Regional Medical Center (the health care center in which the author of this paper conducts a project aimed at improving the PICC insertion procedures and at addressing the problem of reinsertions). The data is examined, and the results are reviewed to find the trends in the sources. Their relation to the project is determined. The results are then summarized.
Examination of the Data
To identify the trends related to a) the complications that occur due to PICC insertion, and b) to the need of PICC reinsertion, the data pertaining to the topic was gathered from a number of research articles that were accessed via online databases such as EBSCOhost, PubMed, Ovid, etc. The articles that were used can be described by the following items: 1) their publication years were between 2012 and 2016; 2) they were published in a peer-reviewed journal; 3) they were related to pediatric or birth-related issues. The last criterion is important due to the fact that one of the main specializations of the Kendall Regional Medical Center, is pediatrics, and it was necessary to examine the information collected from similar organizations. The data was reviewed to find tendencies related to the complications of PICC insertion.
The examined articles contained the findings pertaining to complications that may occur as a result of PICC insertion, mainly in pediatric patients. All of them included the information related to the risk factors influencing the probability of occurrence of the complications. While most studies examined the PICC-related problems in children, one study (Cape, Mogensen, Robinson, & Carusi, 2014) also examined the possible complications of the insertion of the catheters in pregnant women.
Review of the Results
It is evident that, on the average, the complications related to PICC use occur with a frequency that is equal to approximately 17-23 days per each 1000 days that the patients have PICCs installed. For instance, Barrier, Williams, Connelly, and Creech (2012) state that complications took place at the frequency of 19.3 per 1000 PICC days for pediatric patients, whereas Cape et al. (2014) report the frequency of18.5 for every 1000 PICC days for pregnant women. Gasior, Knott, and Peter (2013) report the rate of complications (in particular, deep venous thrombosis) of 1.9% per 1000 days in pediatric patients. At the same time, Ohki, Maruyama, Harigaya, Kohno, and Arakawa (2013) point out that a certain type of complication may occur at a rate of 23 for every 1000 PICC-days in pediatric patients when no specific precautions are taken at catheter insertion (no sterile field preparation; the medic uses small sterile forceps to pull the catheter from the pack and inserts it into the patient without touching the catheter), whereas maximum barrier precautions (“cap, mask, sterile gown, sterile gloves, and large sterile drapes”) and standard precautions (“sterile gloves and small sterile drape”) at catheter insertion led to complication rates of 11 and 17 per 1000 PICC-days, respectively (p. 186).
The articles reported different percentage of complications among patients as well; for instance, Barrier et al. (2012) states that more than 30% of all the patients with PICC had at least one complication, whereas, in the study conducted by Cape et al. (2014), 55.9% of all the patients with PICCs had complications.
In addition, the articles also reported different risk factors for PICC complications. For instance, Barrier et al. (2012) highlight that double-lumen PICCs, PICCs installed into the femoral vein, as well as lower age and larger quantity of daily doses of medications were associated with a greater frequency of complications; for Gasior et al. (2013), risk factors include recent surgery, previously occurring thrombosis, family history of thrombosis, and malignancy of children. Finally, Ohki et al. (2013) report that the longer duration and the proximal placement of PICC were associated with the increased frequency of PICC-related complications. Wrightson (2013) stresses that poor selection of catheter tip location may have a significant influence on complication rates; thus, it is stressed that this issue requires further investigation.
Identifying the Results as a Trend Using the Supporting Evidence
As it was already emphasized, it is possible to state that a trend pertaining to the insertion of PICC is that the frequency of complications is approximately equal to 17-23 days per every 1000 days that patients have PICC installed. However, significant barrier precautions can lead to a much lower amount of complications. This is evident from four of the five reviewed articles (Barrier et al., 2012; Cape et al., 2014; Gasior et al., 2013; Ohki et al., 2013). This trend is shown in the chart.
Another trend is related to the type of complications that patients suffered from. The most often mentioned complications are thrombosis (it is mentioned in all the five articles) and bacteremia (Barrier et al., 2012; Cape et al., 2014; Ohki et al., 2013).
How the Trends May Affect the Project
The trend related to the frequency of complications may prove useful in identifying the best techniques and precaution measures during PICC insertion; the trend pertaining to the most often mentioned complications may also show what aspects to pay attention while conducting the PICC insertion.
Summary of the Results
Interpretation of the results
The results pertaining to the risk factors for complications are related mostly to the conditions that the patients had, and it seems that they cannot be directly utilized in improving the mechanism of PICC insertion and reinsertion. However, the described conditions in which PICC insertion takes place may be used to improve the PICC insertion procedures.
Inference and gaps in the data
The first identified trend (the one related to the frequency of complications per 1000 PICC-days) is somewhat hard to properly interpret due to the fact that Barrier et al. (2012), Cape et al. (2014), and Gasior et al. (2013) do not specify the precaution measures that were employed during PICC insertion, while Ohki et al. (2013) do. It is apparent, however, that these measures may have a significant impact on the likelihood of complications, which is shown by Ohki et al. (2013); in addition, because bacteremia is one of the most often mentioned complications, it is clear that precautions during PICC insertion are paramount.
New information that may impact the project
The facts that precaution measures and such factors as catheter tip location (Wrightson, 2013) may influence the risk of complications and lead to the necessity of PICC reinsertion may be of significant importance to the project.
Conclusion
Therefore, it should be stressed that sources pertaining to the issue of PICC-related complications were reviewed; a number of trends were identified. As a result, it was shown that precaution measures taken during the PICC insertion, and particular components of the procedures (such as the catheter tip location), may affect the number of PICC-related complications and should be scrutinized more closely and reviewed if the number of complications is to be decreased.
References
Barrier, A., Williams, D. J., Connelly, M., & Creech, C. B. (2012). Frequency of peripherally inserted central catheter complications in children. The Pediatric Infectious Disease Journal, 31(5), 519-521. Web.
Cape, A. V., Mogensen, K. M., Robinson, M. K., & Carusi, D. A. (2014). Peripherally inserted central catheter (PICC) complications during pregnancy. Journal of Parenteral and Enteral Nutrition, 38(5), 595-601. Web.
Gasior, A. C., Knott, E. M., & Peter, S. D. S. (2013). Management of peripherally inserted central catheter associated deep vein thrombosis in children. Pediatric Surgery International, 29(5), 445-449.
Ohki, Y., Maruyama, K., Harigaya, A., Kohno, M., & Arakawa, H. (2013). Complications of peripherally inserted central venous catheter in Japanese neonatal intensive care units. Pediatrics International, 55(2), 185-189. Web.
Wrightson, D. D. (2013). Peripherally inserted central catheter complications in neonates with upper versus lower extremity insertion sites. Advances in Neonatal Care, 13(3), 198-204. Web.