Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients.
OBJECTIVE
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.
Tian
Geng
G
Department of Tumor, The First Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China. gengtian71@yahoo.com.cn
Zhu
Yan
Y
Qi
Li
L
Guo
Fengqin
F
Xu
Haidan
H
D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002710:Chlorhexidine / Q000008:administration & dosage; D004509:Education, Nursing, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D011206:Povidone-Iodine / Q000008:administration & dosage; D013902:Radiography, Thoracic / Q000379:methods; D012867:Skin / Q000382:microbiology; D012874:Skin Diseases, Infectious / Q000209:etiology / Q000517:prevention & control*
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D002710:Chlorhexidine