Development Of Clinical Practice Guidelines For Preplacement Assessment Of Peripherally Inserted Central Catheter (PICC)

BackgroundAs advanced vascular access devices, peripherally inserted central catheters (PICCs) provide patients a safe, convenient and effective intravenous route of administration, mainly used for chemotherapy of cancer patients, long-term intravenous infusion, total parenteral nutrition (TPN), antibiotic therapy, etc. However. PICC preplacement assessment of the status quo is not satisfactory in current clinical practice. The degree of attention for PICC assessment before placement is far less than other processes, and whether assessment events are correct or not, how assessment findings guide follow-up practice, all of which is lack of sufficient evidences to be explained. Clinical practice guidelines are systematically developed recommendations for assisting medical staff to make appropriate decisions in specific clinical situation. Compared with mature developed clinical practice guidelines overseas, our application of evidence-based clinical practice guidelines is still less, and lack of specific clinical practice guidelines for PICC preplacement assessment in strict sense. Researchers and clinical nurses should consider our country’s actual medical condition, to search best evidences related to PICC preplacement assessment, to develop native clinical practice guidelines for PICC preplacement assessment, and to apply the clinical practice guidelines correctly and effectively in clinical practice in order to improve quality of care and ensure patients’safety.ObjectiveThis study aimed to explore the real feeling and experiences of patients who determined to undergo PICC placement, to explore the status quo of PICC preplacement assessment and existing problems, to form "Systematic Review of Peripherally Inserted Central Catheter (PICC) Preplacement Assessment""Assessment Form for Peripherally Inserted Central Catheter (PICC) Placement""Informed Consent Form of Peripherally Inserted Central Catheter (PICC) Placement""Placement Refusal Form of Peripherally Inserted Central Catheter (PICC) Placement", to develop "Clinical Practice Guidelines for Preplacement Assessment of Peripherally Inserted Central Catheter (PICC)" and best practice information sheet.MethodsThis study was conducted according to methods to develop evidence-based clinical practice guidelines. In-depth interviews were conducted on20patients who had successful PICC placements using phenomenological method. Key informant interviews were conducted on19PICC professional nurses,1clinical specialist from a certain brand of PICC and2clinical doctors using phenomenological method. Participatory observations were conducted on3hospitals to explore PICC preplacement assessment process. Content analysis method was conducted on10informed consent documents of PICC placement. Databases and Internet sites were searched systematically to form systematic review and obtain relevant guidelines. The above findings were integrated to develop "Clinical Practice Guidelines for Preplacement Assessment of Peripherally Inserted Central Catheter(PICC)" and best practice information sheet.ResultsPatients with PICCs obtained PICC related information mainly from nurses, peers and hospital’s publicity boards, working experiences in hospitals. Patients might weigh the price and security of catheters and selected the insertion site. Patients might be worried about placement failure and they might have some misunderstandings. When signing informed consent forms, patients might obey medical staff, had no choices or encouraged by peers who had successful PICC placement experience. Patients might consider little about availability of PICC maintenance. Patients might choose fully-trusted hospitals to maintain their PICCs and considered it troublesome.PICC professional nurses, clinical specialist and clinical doctors affirmed the important significance of PICC preplacement assessment. Assessment contents included multiple aspects such as patient’s diagnosis and treatment, venous conditions, etc. Also, some problems was discovered such as insufficient assessment, hidden crisis caused by non-insertion nurses to perform PICC assessment firstly and no assessment form was used.10informed consent documents of PICC placement played an organized role in patients’informed consent process, and there emerged the placement refusal form authorized patients to refuse PICC placement. But there were still some rigid and commanding expressions, and incorrect-used medical terminology. Informed consent form from Peking University People’s Hospital could be used as reference to improve current informed consent documents. Through systematically literature retrieval and evaluation,49randomized controlled trails, quasi-randomized controlled trials, case-control studies, cohort studies were included. Including sensitivity analysis and subgroup analysis, a total of41different aspects of the Meta-analysis and20descriptive analysis from49studies were conducted.16clinical practice guidelines related to PICC preplacement assessment were obtained through search, containing23relevant themes. No clinical practice guidelines specific in PICC preplacement assessment was found.The above findings were integrated to develop "Clinical Practice Guidelines for Preplacement Assessment of Peripherally Inserted Central Catheter (PICC)"(draft) and best practice information sheet, including Insertion Nursing Specialist, Environment and Equipments, Patient Assessment, Catheter Selection, Insertion Technique and Insertion Site, and Informed Consent, a total of6aspects and31recommendations.The related attachments of guidelines were revised by Delphi consultation. The clinical practice guidelines were reviewed according to Appraisal of Guidelines Research&Evaluation Instrument to finally form "Clinical Practice Guidelines for Preplacement Assessment of Peripherally Inserted Central Catheter (PICC)" and best practice information sheet.ConclusionPatients’willingness to place PICCs could be encouraged by improving PICC information sources and strengthening publicity and education. PICC preplacement assessment helped patients with PICC placement decision-making and maintenance-planning. Signing informed consent forms was an important part of PICC preplacement assessment processes.PICC preplacement assessment was significantly important and required further improvement in order to promote the clinical application of PICCs."Clinical Practice Guidelines for Preplacement Assessment of Peripherally Inserted Central Catheter (PICC)" were evidence-based clinical practice guidelines based on the clinical status quo in China, evidence-based evidences, wishes and preferences of patients, professional judgments of medical staff.