Nurses' Knowledge Of The Management Of Drug-induced PICC Obstruction:a Descriptive Phenomenological Study

Objectives:To describe and understand nurses' knowledge of the management of drug-induced Peripherally Inserted Central Catheter(PICC)obstruction,and to analyse the reasons of nurses' knowledge about managing drug-induced PICC obstruction.This paper provide suggestions from the perspective of nurses for the management of complications of PICC in China and provide reference for improving the management of PICC obstruction.Methods:The descriptive phenomenological method was used to investigate nurses' knowledge of management for drug-induced PICC obstruction.Semi-structured in-depth interviews with 17 nurses from three hospitals in northeast China were used in this qualitative study.Data collection and analysis was conducted simultaneously during the research.Nvivo software 12.0 was used to organize and code the data,and Colaizzi's seven phases of data analysis were used to form themes.Data collection and analysis were conducted simultaneously during the research.Findings:The findings showed that there is inconsistency in nurses' knowledge of drug-induced PICC obstruction and its management,and we suggest reasons for this phenomenon.Nurses' knowledge of drug-induced PICC obstruction includes the following four themes,which interact with each other and show the current situation of nurses' knowledge of drug-induced PICC obstruction management.Theme1: Inconsistency of PICC obstruction management(1)Nurses' assessment criteria for PICC obstruction are different: most of them judge the degree of catheter obstruction according to the resistance of flushing catheter;some nurses make judgments based on the drip rate of the liquid.(2)Nurse prevention of PICC obstruction varies because of various PICC types,physicochemical properties of drugs,the frequency of medication prescribed,and the patient's condition.(3)Nurses' treatment procedures for PICC obstruction are different because of the characteristics of diseases in different departments: for example,nurses working in gastrointestinal surgery usually consider parenteral nutrition-induced lipid residue obstruction first and use a catheter-clearance agent appropriate for this,while nurses working in Oncology-Hematology department usually consider thrombotic obstruction.Theme2: Consistency of nurses' knowledge of drug-induced PICC obstruction and its management(1)Drug-induced PICC obstruction is rare.(2)The main reason for drug-induced PICC obstruction is that flushing is not timely or flushing technique is not standard.(3)Prevention is key to avoid drug-induced PICC obstruction.Once it occurs,it is difficult to deal.Theme3: Inconsistency of nurses' attitudes of drug-induced PICC obstruction(1)The senior PICC professional nurses are more willing to explore the causes of drug-induced PICC obstruction.(2)The junior nurses get a loss due to the difficulty in determining the causes of obstruction.Theme4: The phenomenon that there are differences in the management of drug-induced PICC obstruction for nurses is affected by many factors.(1)Due to the pressure of nurses' clinical working hours and the vague indication of PICC extubation,the management procedure of drug-induced obstruction is limited.(2)Lack of catheter clear agents and the poor efficiency of clear agents are the obstacles to the management of raw materials for drug-induced PICC obstruction.(3)The lack of doctor's prescription of catheter clear agent and guidance of pharmacists are the limitations of working model.There was a communication disconnect between bedside nurses and PICC professional nurses in this management model.Conclusions:Conclusion 1: The knowledge of nurses on the management of drug-induced PICC obstruction includes the knoweledge of prevention and treatment of drug-induced PICC obstruction.The knoweledge of prevention is better than that of treatment.Most participants think that the prevention of drug-induced obstruction is more important than treatment.Conclusion 2: Different hospitals and different departments have different management plans,which is closely related to the PICC management standard adopted by the hospital,the disease characteristics of patients and the characteristics of medication.Conclusion 3: The reasons for the differences of nurses' knowledge of drug-induced PICC obstruction are mainly including the limitations of drug-induced PICC obstruction management procedures,the limitations of catheter agent,and the limitations of working model.Suggestions: Department managers need to strengthen the awareness of bedside maintenance nurses on the management of PICC obstruction;hospital management also needs to improve the current assessment system,combined with daily assessment,stage assessment and clinical assessment,to establish a all-around PICC training mechanism;PICC professional nurses,as experts in PICC management,adjust the practical standards of PICC obstruction management in China,and establish the appropriate national conditions to ensure the implementation of clinical treatment.