Safety and Efficacy of An Educational Program in Reducing Complications of Peripherally Inserted Central Catheters (PICCs) in Haematological Patients,

Patients with haematological disorders frequently require the insertion of medium or long-term central venous catheters (CVCs) for stem-cell transplantation, the administration of chemotherapy, or transfusion of blood products. Although peripherally inserted central catheters (PICCs) have been in use for many years, little data exist on their use in patients receiving intensive chemotherapy.

Evidence-based interventions were implemented in our department in December 2010, and include:1.An high level nurse education program for correct practices and prevention of catheter-associated complications. was developed for PICC nursing team;2) The use of ultrasound guide for the insertion of the tip of PICCs, thanks to a special operator training; 3) Bedside placement and confirmed PICC tip placement by chest radiography after removal of the guidewire and before the securing of the catheter; 4) Maintenance of maximum sterile barrier precautions during PICC insertion and aftercare; 5) chlorhexidine preparation, replace 10% povidone iodine for skin antisepsis; 6) adoption of PICC patient nurse archive, including the information of weekly PICC line review at our department for each patient. Here, we carried out a clinical investigation to determine the efficacy of these interventions in reducing the rate of PICC-related complications (thrombotic events, exit site infection and other complications requiring early removal of PICCs) and to compare PICCs-specific complications (CR-BSI) with a cohort population defined as each consecutive CVC non tunneled inserted over a 6-month period (May–November 2009), and before these evidence-based interventions.

Ninety-five PICCs were in place for a total of 7,295 PICC days ( range, 1–331 days; mean, 76,7 days), and fifty-one CVCs were inserted before these interventions (range, 3–577 days; mean, 176,2 days). Sixty-six PICCs were inserted during severe thrombocytopenia (platelets < 50 × 10(9)/L), and 70 during severe neutropenia (neutrophils < 0.5 × 10(9)/L). The majority of the patients were affected by leukaemia, and PICCs were inserted to ensure adequate access throughout chemotherapy. There were 2 thrombotic complications PICC-related (0,27 per 1,000 CVC days), and only one CRBSI (0,14 per 1,000 CVC days) during neutropenia. Other mechanical complications occurred in 11 catheters, and were accidental dislodgement (4), catheter break (3), catheter inadequate (4). Compared with CVCs group, the PICCs group was associated with a lower incidence of CRBSI complication rate (1,05% vs 41,17%, 0,14 vs 3,67 per 1,000 CVC days) [odds ratio (OR) 0,051; relative odds reduction (ROR) 0,98].

Our results indicate that a training and competence assessment program is effective in reducing the main complications PICCs-related in haematological setting.

No relevant conflicts of interest to declare.