The Survey Of Practice Status Of PICC From Secondary And Tertiary Hospitals In Shandong Province

Objectives:To investigate the development and practice status of PICC from secondary and tertiary hospitals in Shandong province;to find out problems to be solved in clinical practice.Analysis the cause and provide specific improvement measures,at the same time also provide baseline data for the guide.Methods:A cross-sectional descriptive study design was adopted.The study was based on the previous work to establish the PICC maintenance network of Shandong province.A total of 235 secondary and tertiary hospitals and 611 PICC departments in Shandong province were investigated with self-designed questionnaires,including the development situation of PICC placement,the quality and safety management status of PICC,the construction of PICC nurses,the practice of assessment,insertion and maintenance of PICC.Data were calculated by SPSS 20.0 statistic software,including descriptive analysis,independent t-test and Chi-square test.Results:1.Development situation of PICC placement:①All hospitals had carried out PICC placement,the average development time was 6.51 ±3.53 years.And the development time in tertiary hospitals was longer than secondary hospitals,the difference was statistically significant(t=6.43,P<0.01);②Median number of PICC placement was 120.The number of PICC placement in tertiary hospitals was more than secondary hospitals,the difference was statistically significant(t=5.60,P<0.01);③Departments which carried out PICC placement varied largely among hospitals,and oncology departments,radiation departments,hematology departments use PICC most;④All hospitals had carried out traditional PICC placement,164 hospitals(69.79%)had carried out modified Seldinger technique,127 hospitals(54.04%)had carried out ultrasound guided PICC placement;⑤PICCs were mostly used for chemotherapy,followed by difficulty of peripheral venipuncture,and longterm infusion therapy,parenteral nutrition,salvaging;⑥85 hospitals(36.17%)had established PICC clinic;In other 150 hospitals which did not establish PICC clinic,79 hospitals’ units had equipped with specialized room for PICC placement.2.Quality and safety management status of PICC:① 179 hospitals(52.67%)established IV nurse team,86.92%of the tertiary hospitals established IV nurse team,which was higher than that of the secondary hospitals(67.19%),the difference was statistically significant(χ2=12.50,P<0.01);②Quality control methods:giving priority to quality inspection regularly(78.30%)and examination regularly(66.81%);③215 hospitaIs(91.49%)had PICC insertion procedures,219 hospitals(93.19%)had PICC maintenance procedures,110 hospitals(46.81%)had PICC extubation procedures,53 hospitals(22.55%)had PICC related complication treatment procedures;④PICC related documents:giving priority to informed consent documents for PICC placement(100.00%),PICC insertion records(82.13%)and PICC maintenance records(82.55%).3.Construction of PICC nurses:①There were 1335 trained and certificated nurses while 1382 nurses engaging in PICC catheterization,and there were more PICC catheterization nurses in tertiary hospitals than secondary hospitals,the difference was statistically significant(t=7.23,P<0.01).7.81%of the PICC catheterization nurses worked full-time and 31.91%had a manager position;②PICC catheterization nurses’selection criteria:51.06%of the hospitals had set up clear selection criteria for PICC catheterization nurses,mainly focusing on education background,professional tittle and(or)work experience;③PICC catheterization nurses’ training:organization in PICC training was diversified,giving priority to nursing association in province(71.91%)and nursing association in city(65.53%).PICC catheterization nurses in only 20.43%of the hospitals would accept training annually,31.49%of the hospitals would re-certificate PICC nurses.4.Practice of assessment before PICC placement:① All apartments would assess before PICC placement.Assessors were not PICC catheterization nurses in 12 apartments(1.96%);②Among the content of the assessment,the evaluating rate of blood vessel condition and laboratory indexes were above 90%;Secondly,patients’physical condition,treatment duration,risk factors and drug properties were assessed;the evaluating rate of financial situation and accessibility for maintenance were under 50%;③Basis for the assessment:mainly based on the knowledge and experience form self study(66.94%);④Record for the assessment results:61.87%apartments did not record the assessment results;⑤Announcer and signatory of informed consent documents for PICC placement:announcers include only PICC catheterization nurses(48.45%),both PICC catheterization nurses and doctors(41.41%),only doctors(7.20%)and only ward nurses(2.95%);Signatory include both PICC catheterization nurses and doctors(43.21%),only PICC catheterization nurses(34.04%)and only doctors(22.75%).5.Practice of PICC insertion:① External measurement methods of PICC:the most common used method is from the planned insertion site to the third intercostal space(35.19%);② Type of disinfectant:giving priority to 2%tincture of iodine with 75%alcohol(32.41%),iodophor solution including effective iodine above 0.5%(30.61%)and Anerdian(21.44%);③ Type of sterile pack:25.53%apartments use sterile packs which were disinfected by supply apartment,other 74.47%apartments use disposable sterile packs;④Establishment of sterile barrier:most of the apartments could equip with sterile isolation gowns,surgical masks,caps and gloves,67.10%apartments could cover sterile drapes on patients’ whole body,respectively 46.32%and 24.39%apartments could wear surgical masks and caps for patients;⑤Catheter tip positioning of PICC:the most common positioning method is chest X-rays.6.Practice of PICC maintenance:①Type of infusion connector:93 apartments(15.22%)only used heparin caps,500 apartments(81.83%)only used needleless connectors,both heparin caps and needleless connectors were used in 18 apartments(2.95%);② Type of dressing:504 apartments(82.49%)used transparent dressing at the puncture site,107 apartments(17.51%)used gauze dressing;③Concentration of solution for locking PICC:20.79%apartments locked PICC with saline solution,while other 79.21%apartments used heparin solution;④Catheter fixing device:respectively 188(30.77%)and 100(16.37%)apartments used tape and Statlock to fix PICC.Conclusions:1.PICC has been developed rapidly in Shandong province in recent years,but the development is not balanced,especially primary hospitals should be further reinforced.2.Quality and safety management of PICC is not impeccable,a comprehensive and sustained way of quality control is to be expected.And PICC related procedures should be further specified.3.PICC nurse team has been preliminarily established,but nursing staff deployment was unevenness.The selection criteria of PICC nurses should be further standardized,and the training space should be further promoted.4.Practice of assessment before PICC placement is not optimistic.The content of the assessment,basis for the assessment and record for the assessment results are lack of uniform standards.5.Practice of PICC insertion should to be further standardized.External measurement method,type of disinfectant and sterile pack,establishment of sterile barrier and catheter tip positioning remains to be improved.6.Practice of PICC maintenance should to be further unified.There are still some disputes on some aspects:type of infusion connector and dressing,concentration of solution for locking and catheter fixing device.