Running head: Benefits of a Peripheral Intravenous Central ...



Running head: Peripheral Intravenous Central Catheter Complications

Peripherally Inserted Central Catheter Complications

Shanda Christiansen

Ferris State University

Peripherally Inserted Central Catheter Complications

The use of venous access devices has been used for decades in the nursing field for intravenous infusion therapy. There are many types of venous access devices. Those include ports (MediPort or Port-a-Cath), central lines, and peripheral IVs. Inserting a peripheral IV can be quite challenging. Sometimes it takes several attempts to achieve a patent IV and it can be quite painful for the patient. A peripheral IV is good when the intravenous treatment is short term and a vesicant is not being used. But when treatment is prolonged in the case of long chemotherapy regimens, extended antibiotic therapy, or total parenteral nutrition (TPN) a peripherally inserted central catheter (PICC line) has its advantages.

In my area of practice, as a home infusion nurse, I treat patients that are usually on long term intravenous therapy. Most patients I see that are on intravenous antibiotics or TPN have a PICC line. The PICC line is maintained by the patient on a daily basis with daily site checks, flushing, and administering medication. The PICC is maintained by me weekly with sterile dressing changes, blood draws, or removing the line. Managing a PICC in the home can be quite challenging at times due to patient non-compliance, (e.g. not scrubbing the cap with alcohol before hooking up to the line) environmental factors, (e.g. the area where the infusion takes place is not clean) and possible complications. When a patient has a PICC line it makes my job a lot easier. It also makes it easier for the patient.

Complications related to PICC lines include infection, occlusion, and deep vein thrombosis. “To limit the risk of infection you need to follow evidence based infection control guidelines: Hand hygiene, sterile dressing changes, cleaning catheter hubs, and caps daily, changing IV fluids and tubing as recommended, and preventing (or eliminating) occlusions all help prevent infections that could lead to septicemia and death” Eggimann & Pittet (2002). The most common complications I see are occlusions, which in most cases can be resolved with Cathflo Activase to de-clot the access device.

According to Bowe-Geddes & Nichols, peripherally inserted central catheters (PICCs), which have the lowest infection rate of any central line, have become the access device of choice. Also, new technology has improved the insertion process of PICC line placement. PICC lines has many advantages for patients on long term infusion therapy including the constant need for blood draws which can be done right from the PICC line.

The first article I researched was managing complications of central venous access devices by Sue Masoorli, RN. In this article Masoorli describes the four types of central venous access devices and how each one works. She then explains the complications associated with these devices and what to do if something goes wrong. For infection related complications she points out multiple factors that increase a patient’s risk for catheter related sepsis and how to prevent them. She explains what an air embolism is how it is caused. An air embolism is a risk when a central venous access device is inserted or removed and when you change tubings or caps. Massorli implies the risk is increased if, while you’re manipulating the system, the patient’s intrathoracic pressure changes (for example, during coughing, sneezing, crying, or laughing.) This is very important due to the fact that I change numerous caps and tubings everyday.

The second article was keeping central line infection at bay by Lynn C. Hadaway, RN, C, CRNI. This article explained ways of preventing infections from the very start beginning with the insertion of the PICC line. The article describes certain skin antiseptics that should be used during PICC line insertion and dressing changes. “A recent meta-analysis of studies comparing chlorhexidine with povidine iodine for routine insertion-site care showed that chlorhexidine was superior for preventing catheter related blood stream infections and didn’t cause adverse reactions at the puncture site” (Hadaway 2006). The article also described the technique for applying the chlorhexidine by using a back and fourth scrubbing motion to cause friction. I will incorporate this technique in my practice since I was taught to start at the insertion point and use a circular motion out and away from the insertion point.

The third article was how to manage PICCs by Denise Macklin, BSN, RN, C, CRNI. Macklin describes physical characteristics of PICCs, factors influencing flow rate, dealing with complications, insertion site care and infection control, removing the catheter, and catheter events to watch for. She also explains step by step the stopcock method for de-clotting a PICC. This was very interesting to me since I have never used this method in my practice. I would normally infuse the medicine that de-clots the line, wait at least 1 hour, and draw back to remove the clot. The stopcock method has a wait time of 15 minutes. This could really reduce time spent at trying to remove an occlusion.

I found all three articles to be very helpful and useful in my everyday practice. The articles gave me a refresher on how complications arise and how to prevent them. But none of these articles showed statistics related to central access devices and the complications associated with them.

I found that Betty Neuman’s Systems Model to be an effective theory in regards to PICC line complications. The model explains prevention as intervention. There are three levels of prevention. Primary prevention is when there is a risk but no reaction has occurred. Secondary prevention is when interventions have started to reduce the reaction. Tertiary prevention is after active treatment has started and maintaining the patient in the best possible state. “The purpose of prevention as intervention is to achieve the maximum possible level of client system stability” (Tomey & Alligood 2006). Knowing how to intervene when complications arise is a must but preventing complications from happening is the first line of defense for maintaining a PICC line.

References

Bowe-Geddes, L.A., & Nichols, H. A. “An overview of peripherally inserted central

Catheters.” 2005. viewarticle/508939 (26 June 2006).

Eggiman, P., & Pittet, D. (2002). Overview of catheter-related infections with special

Emphasis on prevention based on educational programs. Clin Microbiol Infect, 8(5),

295.

Hadaway, L.C. (2006). Keeping central line infections at bay. Nursing2006 36(4)



Macklin, D. (1997) How to manage PICCs. The American journal of nursing, 97(9), 26-

33

Masoorli, S. (1997). Managing complications of central venous access devices.

Nursing1997 August. ce.htm.

Tomey, A., & Alligood, M. (2006) Nursing Models. In Y. Alexopoulos et al. (Ed.),

Nursing theorists and their work (pp. 318-336). St. Louis, MO

NURS 324 EVIDENCE BASED PRACTICE PAPER/PRESENTATION

STUDENT NAME__________________________________________

|DESCRIPTION AND ANALYSIS OF PRACTICE ISSUE |POINTS POSSIBLE |POINTS AWARDED |

|Clear Introductory Description of Practice Concern/Interest: Describes reason for |10 | |

|interest or concern and description of issue. | | |

|Practice Environment: |5 | |

|Provides clear description of practice area. | | |

|Causal Factors: Personal Perspective and Description/Analysis of Possible Contributing |10 | |

|or Causative Factors for the Concern | | |

|Defined Area of Research Search: Narrows down and defines a specific area for research |5 | |

|review and provides a clear statement of same. | | |

|RESEARCH REVIEW | | |

|Research Findings: Shares the findings of a minimum of 3 research articles from | | |

|professional journals on the selected topic. Briefly describes the research approaches |20 | |

|and findings of each. | | |

|Critique of the Research: Attempts to point out any research limitations/credibility of |5 | |

|the studies. | | |

|Implications For Practice: Identifies potential practice implications of research. This |5 | |

|goes beyond implications included in the study itself, to include perceptions of | | |

|implications for personal practice. | | |

|Critical Reflection: Identifies a nursing theory that this practice concern/research |10 | |

|findings is an appropriate fit. Includes reflections on the significance/implications of | | |

|integrating research into practice. | | |

|STANDARDS & APA CRITERIA | | |

|APA: Attaches and adheres to Writing Checklist and APA manual guidelines. Length |15 | |

|appropriate (5-6 pages of typed content excluding the reference page, abstract, and title| | |

|page). | | |

|MINI PRESENTATION: Provides a summarized presentation of findings and theory correlation |15 | |

|to peers in the online setting. Presents in a creative, interesting, and succinct manner | | |

|main components of the issue and findings. | | |

|TOTAL POINTS |100 | |

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