Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients

Support Care Cancer. 2010 Oct;18(10):1293-8. doi: 10.1007/s00520-009-0747-7. Epub 2009 Sep 29.

Abstract

Purpose: To evaluate the efficacy of multifaceted interventions in reducing complications of peripherally inserted central venous catheter (PICC) in adult oncology patients.

Methods: Multifaceted interventions were implemented in our department in December 2006. These interventions include: (1) A mandatory nurse reeducation was developed by a multidisciplinary task force; (2) Modification of peripherally inserted central catheter insertion: take a chest X-ray before removal of the guidewire and cutting of the catheter. The guidewire in the catheter facilitates the accurate location of the tip of PICC on chest X-ray and make the malposition correction (withdrawing, reinsertion, even reinsertion following withdrawal) easily; (3) Using a 2% chlorhexidine preparation, replace 10% povidone iodine for skin antisepsis; (4) Maintenance of maximum sterile barrier precautions during PICC insertion and aftercare; (5) Designing of a PICC archive form and establishing a PICC archive for each patient. The PICC complication rates of groups before and after interventions were evaluated and compared.

Results: Sixty-nine PICC lines were inserted before these interventions, and 165 were inserted after implementation of these interventions. Compared with preintervention group, the postintervention group was associated with a 62.14% decrease in the overall complication rate (11.52% vs 30.43% [P = 0.0004]; incidence density, 1.82 vs 4.62 per 1,000 PICC days) with a 67.48% decrease in the infective complications rate (4.24% vs 13.04% [P = 0.015]) with a 58.19% decrease in the noninfective complications rate (7.27% vs 17.39% [P = 0.0199]).

Conclusions: The results suggest that these interventions implemented in this study may be help in reducing complications of PICC in adult oncology patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Infective Agents, Local / administration & dosage
  • Catheter-Related Infections / prevention & control*
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / instrumentation
  • Catheterization, Central Venous / methods*
  • Catheterization, Peripheral / adverse effects
  • Catheterization, Peripheral / instrumentation
  • Catheterization, Peripheral / methods*
  • Chlorhexidine / administration & dosage
  • Education, Nursing, Continuing / methods
  • Female
  • Humans
  • Middle Aged
  • Neoplasms / drug therapy
  • Povidone-Iodine / administration & dosage
  • Radiography, Thoracic / methods
  • Skin / microbiology
  • Skin Diseases, Infectious / etiology
  • Skin Diseases, Infectious / prevention & control*

Substances

  • Anti-Infective Agents, Local
  • Povidone-Iodine
  • Chlorhexidine