The Impact of Focused Nursing Education on PICC Occlusion Rates Dayna Holt, RN, CRNI Rady Children’s Hospital, San Diego
BACKGROUND • Peripherally inserted central catheters (PICC) have become an essential tool in pediatric care. • At Rady Children’s Hospital 550 to 600 pediatric PICCs are placed annually. • The small lumen and length of pediatric PICCs requires specialized skill and knowledge in proper care and maintenance.
THE PROBLEM • Occluded catheters compromise patient care and increase costs. • Necessary medications and fluids are delayed and can affect patient outcomes or delay discharge. • Considerable nursing time is required to restore the patency of occluded catheters. • Occluded PICCs can result in patient dissatisfaction, anxiety, discomfort and stress.
PICO QUESITON • Population~ Patients with 3F Groshong PICCs. • Intervention~ Focused nursing education specifically designed to prevent and reduce catheter occlusions. • Comparison~ Basic nursing orientation and the availability of policy and/or mentors for reference. • Outcome~ Occlusion rates of 3F Groshong PICCs.
PICO QUESTION In patients with 3f Groshong PICCs, does implementing a focused nursing education as compared to basic orientation and the availability of policy and procedures decrease catheter occlusion rates?
SYNOPSIS OF EVIDENCE • Recognizing the causes of PICC occlusion assists the nurse in preventing occlusion occurrences. • Proper flushing, catheter care and lab sampling technique reduces the occurrence of PICC occlusions.
SYNOPSIS OF EVIDENCE • Nursing knowledge in the care and flushing of PICCs reduces total catheter occlusions. • Recognizing and treating partial catheter occlusions prevents the occurrence of total catheter occlusions. • 3F Groshong PICCs can be utilized effectively for lab sampling with out significant increases in catheter occlusion rates.
METHODS • A Pre-Test/Post-Test project was designed. • Convenience sample of all core staff nurses working in Med/Surg at RCHSD May 2007 to August 2007. • All data was aggregated and anonymous.
METHODS • Objective written Test of nursing knowledge. • Direct observations of nurse’s PICC flushing technique. • Retrospective chart review to determine catheter occlusion rates.
DATA COLLECTION • Retrospective chart review December 1, 2006 through February 28, 2007 (N=97) • Direct nursing observations April 16, 2007 through May 9, 2007 days and nights (N=37) • Written Pre-test followed by educational intervention at Med/Surg mandatory annual education May 2007 (N=101)
DATA COLLECTION • Written post-test June, 2007 (N=53) 4 tests returned in August 2007 • Direct nursing observations August 2007 days and nights (N=39) • Retrospective Chart Review June 1, 2007 through August 24, 2007 (N=92)
RESULTS • Nursing knowledge increased • Pre-test mean written test score 0.78 • Post-test mean written test score 0.93 • (p=<0.0001 equal variances t-test 1 tailed) • Nursing flushing technique improved • Pre-test mean observation score 0.88 • Post-test mean observation score 0.95 • (p=0.0045 unequal variances t-test 1 tailed) SSPS statistical software version 14.0
RESULTS • Pre-test occlusion rates: • M/S 21.11/1000 catheter days (N=55) • Non M/S 18.92/1000 catheter days (N=42) • Post-test occlusion rates: • M/S 15.49/1000 catheter days (N=50) • Non M/S 24.24/1000 catheter days (N=42) (Med/Surg p=0.0515 unequal variances t-test 1 tailed) (Non Med/Surg p=0.45 equal variances t-test 1 tailed) SSPS statistical software version 14.0
LIMITATIONS • 50% written post-test return. • Post-test observations completed over 2 months after focused education. • Post-test observations completed by simulation rather than actual patient observations.
LIMITATIONS • Nursing attrition during the study period. • No provision post intervention for 3F Groshong PICC care only by nurses who participated in the focused education.
CONCLUSIONS • Focused Nursing Education improved nursing knowledge and flushing technique. • Focused Nursing Education significantly reduced 3F Groshong PICC occlusions and the associated costs due to PICC occlusions.
RECOMMENDATIONS • Consider other evidenced-based projects to determine if product selection or cap design has an impact on the rates of catheter occlusion. • Annually provide PICC specific focused education to all RNs responsible for the care of PICCs.