This document summarizes the evidence-based incorporation of peripherally inserted central catheters (PICC) for cancer patients at Araba University Hospital. A literature review and training program was conducted before developing a protocol for PICC insertion, maintenance, and patient education. Over 200 PICCs were successfully inserted with few complications. PICCs provided a safe, effective long-term venous access alternative to implanted ports or central venous catheters at a lower cost. The process demonstrated how new technologies can be incorporated into clinical practice using an evidence-based approach.
pA2 value, Schild plot and pD2 values- applications in pharmacology
Incorporating Peripherally Inserted Central Catheters (PICC) into hospital clinical practice
1. Incorporating Peripherally Inserted
Central Catheters (PICC) into hospital
clinical practice
An example of evidence based process
Lucia Garate Echenique
Nursing Research Supervisor
lucia.garateechenique@osakidetza.net
3. Background
• Incorporating technology into hospital clinical practice
FEARS ECONOMICAL
ACHIEVEMENT OF
MANAGEMENT OBJETIVES RESURCES
PREVIOUS
CONCESSIONS
PROFESSIONAL
ATTITUD
PURCHASING PATIENT
COMMITTEE PREFERENCES
IMPRESSIONS OF PREVIOUS
CLINICAL BENEFIT PURCHASES/
INVESTMENTS
4. Background
PICC : Peripherally Inserted Central Catheter
Long-term: Third generation polyurethane or silicone
Inserted in upper arms: Peripherally inserted
End of catheter in superior cava vein
Can be inserted at bed-side by trained nurses
5. Background
LIFE CYCLE OF
HEALTH TECHNOLOGY
EMERGING
TECHNOLOGIES
6. Background
“Technologies have occasionally had rapid development and
dissemination in the health care system (…) influenced by factors
such as social pressure, commercial pressure, the enthusiasm of
health professionals, lack of barriers to their implementation or the
existence of technical difficulties for evaluation. This fact has led
sometimes to further demonstrate its ineffectiveness and even
harm.”
The EARLY ASSESSMENT OF EMERGING TECHNOLOGIES aims:
1. To identify characteristics in terms of improvement in clinical
practice, adverse effects, ethical and economic aspects.
2. To Help in the decision-making
3. To Prevent the undesirable consequences of the introduction
of new health technologies.
7. Objective
• To describe the evidence-based incorporation of
PICC for cancer patients in the Araba University
Hospital.
8. Methods
1) Bibliographic review: January 2010-June 2010
2) Nurses education/ training
3) Protocol desining: prior, insertion, postinsertion, education
for patients.
4) Database monitoring: success in placement, incidences,
duration, reasons for withdrawal, complications. June
2011.
5) Request to the Purchasing Commitee.
Acceptance: PICC (October 2010) & Ultrasound (Febreary
2011).
6) Observational prospective study
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N=218 Inserted in Araba University Hospital
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Results
15. Results
100 100 100 100 100 100 100 100
95 94
90 91 90 92
84
80 80
75
70
66
60
56 54
% 50 50 50
40
30
20
INSERTION SUCCESS RATE 96.3% (CI 95%: 92.9 – 98.1)
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16. Results
Withdrawed
N 90
Catheters
Mean 147.6
Median 99.5
Stand. Dev. 122,.2
Mín. 9,0
Max. 533.0
25 50,0
Percentiles 50 99.5
75 235.5
17. Results
TOTAL: 24,031 Catheter Days
Nº of Adverse Effects: 49
Adverse Effect TOTAL CATHETER DAYS = 24.031
95% CI: 1.5-2.7 /1,000 Catheter-Days
1
0,9
Complication/1,000
0,8
0,40
Catheter-Days
0,7 0,66
0,6
0,5 0,24
0,4
0,29 0,16
0,3 0,08 0,08
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19. Discussion
• PICC are an example of how technology can be incorporated
into hospital practice based on evidence criteria.
• However, the vast amount of technology hospitals manage and
the effort needed to search, read, and create evidence
constitute important difficulties to be faced in the technology
incorporation processes.
• In hospital routine this proccess may be insufficiently
protected. The creation of hospital based technology
evaluation committes could support the proccess of
incorporation technology following evidence-based criteria.
21. Implications for Practice
• PICC is now an available, safe, and cost-effective central
venous device in our hospital, preferable to other devices for
cancer patients.
• When the process of adquiring technology in hospitals involves
practicioners, researchers, material resources responsibles,
and managers it is easier to incorporate technology which is
relevant and appropriate, in both scientific and economical terms,
to clinical practice.
22. Thank you
Eskerrik Asko
Gracias
Lucia Garate Echenique
Nursing Research Supervisor
lucia.garateechenique@osakidetza.net
Notas do Editor
As Osteba implicitly acknowledges, incorporation of technology into clinical practice is not always based in scientific evidence criteria. In our hospital the incorporation of new technology is usually as follows: Clinicians hear about new technologies in congresses or meetings. Comercial agent offers the product to clinicians or material resources responsible. Clinicians test the product, in best of cases, read about the product. If they like it, they request it to the purchasing commitee, providing bibliographic references, use description… Purchasing commettee makes the decision. The purchasing commitee is integrated by: Director Económico-Financiero HUA Director Médico HUA………..Delega en Subdirector Médico HUA Directora Enfermería HUA………..Delega en Responsable de RR.MM HUA Subdirectora Económica Compras HUA Responsable Gestión Económica HUA Responsable Compras Txagorritxu And asks for the following information in the application form: +Justify the need of the product or device +Expected benefits/ Beneficios esperados con la adquisición del nuevo producto/técnica referidos a: +Safety and technical quality +Work organization changes +Improvement in diagnosis or therapeutic techniques +Economical impact +Use of technology in other hospitals +Bibliography supporting the benefits of the new product/ device or technique. Calidad técnica y seguridad Modificaciones en la metodología de trabajo Beneficios referidos al paciente Mejoría de las técnicas diagnosticas/terapéuticas empleadas Impacto económico Referencia de su uso en otros hospitales Soporte bibliográfico: existencia de evidencia científica de los beneficios de la utilización del nuevo producto ó técnica.
As Osteba implicitly acknowledges, incorporation of technology into clinical practice is not always based in scientific evidence criteria. In our hospital the incorporation of new technology is usually as follows: Comercial agent offers the product to clinicians or material resources responsible. Clinicians test the product, in best of cases, read about the product. If they like it, they request it to the purchasing commitee, providing bibliographic references, use description… Purchasing commettee makes the decision. The purchasing commitee is integrated by: Director Económico-Financiero HUA Director Médico HUA………..Delega en Subdirector Médico HUA Directora Enfermería HUA………..Delega en Responsable de RR.MM HUA Subdirectora Económica Compras HUA Responsable Gestión Económica HUA Responsable Compras Txagorritxu And asks for the following information in the application sheet: Justificación de la necesidad ó conveniencia de su incorporación Beneficios esperados con la adquisición del nuevo producto/técnica referidos a: Calidad técnica y seguridad Modificaciones en la metodología de trabajo Beneficios referidos al paciente Mejoría de las técnicas diagnosticas/terapéuticas empleadas Impacto económico Referencia de su uso en otros hospitales Soporte bibliográfico: existencia de evidencia científica de los beneficios de la utilización del nuevo producto ó técnica.
This is what we have try to do with PICC. Purchasing Commitee doors seem to be closed at that time. How did we opened them? This is an example of evidence criteria process.
The results of the bibliographical search and some clinical practice guidelines supported the PICC use for cancer patients going into quimotherapy. So we decided start using it, monitooring closelly all the results achived. With this aim a database was designed. In this database the nursign supervisor and main lider of this project of incorporating PICC to the hospital practice, recorded every PICC placement and every incidence ocurred with them. Data were recorded from the very begining, June 2010, and are at the moment still being recorded.
Una diapositiva con el aprendizaje de las enfermeras: investigacion (busqueda y lectura critica), profundización en conocimientos de terapia intravenosa, y por ultima técnica de inserción de PICC (Pata de pavo y ecógrafo). Fruto de esto fueron las mismas enfermeras de la planta las que diseñaron los protocolos de insercion, mantenimiento y adiestramiento a pacientes. Nurses Education and Trainning Programme: Research methodology, IV therapy, simulated practice and real practice.
Including learining period
Actualizar datos
Others like catheter migration, catheter damage, inflammation at the insertion point
From Jan 2012 to Jun 2012 were consumed 12. Cancer of colon screening started 2011. Direct cost Indirect staff/facilities costs