CE Article: Use of an Evidence-Based Protocol for Repositioning Peripherally Inserted Central Catheters (PICCs) in Children and AdultsCE

Abstract

Introduction: Achieving and maintaining optimal peripherally inserted central catheter (PICC) tip position can be challenging. At any time during therapies, the final catheter position can be altered due to changes in patient condition and intrathoracic pressure. Aim: To determine if the use of a standardized protocol with power flush option for repositioning the PICC tips will reduce the number of withdrawal interventions or exchange procedures. Methods: Johns Hopkins evidence-based practice (EBP) methodology was used to evaluate literature published in the past 5 years. A standardized protocol was developed and implemented in patients with malpositioned PICCs. The outcome measures were the successful repositioning of the catheter and costs for the procedure. Results: In 4 months, 43 (93%) of 46 (14 adult/32 pediatric) catheters were successfully repositioned. The withdrawal method was used to reposition 34 (73.9%). In 12 patients where a power flush was used, 9 (75%) were successfully repositioned. These changes resulted in decreased delays in treatment and financial savings of $235,210 in personnel time and supplies. Discussion: The standardized protocol provided an alternative to previous practices, extending dwell time, decreasing treatment delay, and unnecessary procedures, showing significant savings for the institution. Conclusions: The Vascular Access Team use of an evidence-based protocol was successful in reducing catheter exchange and withdrawals in malpositioned catheters among adult and pediatric populations. Relevance to Clinical Practice: The implementation of a standardized EBP to address malpositioned catheters resulted in the decreased need for catheter exchange, reduced delays in treatment, and cost savings.