Evaluation of a unique, nurse-inserted, peripherally inserted central catheter program.
BACKGROUND
Concerns regarding the safety and success of peripherally inserted central catheters (PICCs) placed at the bedside in the pediatric population initially precluded the development of a nurse-inserted PICC program at our pediatric center. Previously, all PICCs were inserted by interventional radiologists (IRs) with fluoroscopic guidance. A new nurse-inserted PICC program was initiated with collaboration between PICC nurses and IRs.


METHODS
Three nurses participated in the project. Patients who met preestablished selection criteria were approached. All insertions were performed with sterile technique on the fluoroscopy table, with IRs available to support the PICC nurse. Veins were accessed visually or through palpation. Final tip position was confirmed in all cases with contrast material administration and fluoroscopy. Additional fluoroscopy was performed only if placement difficulties were encountered. All patients were monitored prospectively.


RESULTS
Ninety-nine patients (age: 3-18 years; average age: 13.6 years) met the selection criteria. Two patients underwent primary insertion by an IR. The remaining 97 patients underwent an insertion attempt by a nurse. Sixty-nine PICCs (71.1%) were placed successfully by a nurse, 15 (15.5%) required minor assistance from an IR, and 13 (13.4%) were inserted by an IR after an unsuccessful nurse attempt. No insertion complications were noted. Insertion difficulties included difficulty advancing the catheter (19.6%), difficulty cannulating the vein (6.2%), and tip malposition (2.1%). Postinsertion complications occurred for 27.8% of PICCs, and 13.4% required removal before the end of therapy.


CONCLUSIONS
This novel, pediatric nurse-inserted PICC program has a good safety profile, high success rate, and low postprocedural complication rate.
Gamulka
Beth
B
Vascular Access Program, Hospital for Sick Children, Toronto, Ontario, Canada. beth.gamulka@sickkids.ca
Mendoza
Cristina
C
Connolly
Bairbre
B
D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001458:Bandages; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods* / Q000451:nursing; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006491:Hemothorax / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007239:Infections / Q000209:etiology; D007297:Inpatients; D008297:Male; D010045:Outpatients; D010173:Palpation; D010348:Patient Care Team; D011446:Prospective Studies; D015642:Radiology, Interventional
D000925:Anticoagulants; D006493:Heparin