Background: Peripherally inserted central catheters (PICCs) are essential devices used to provide central venous access. However, they are often placed inappropriately, leading to unnecessary risk of PICC-related complications. Vascular access operators typically place the majority of PICCs, yet little is known about these specialists and their beliefs regarding PICCs. We therefore conducted a national survey of vascular access providers to assess their practices and experience regarding PICCs.
Methods: A web-based survey was administered to members of two professional vascular nursing societies with a combined membership of 8385 (of which an estimated 5662 are PICC operators). Those who did not place PICCs or had taken the survey previously were excluded. Questions regarding experience, practice, knowledge and beliefs related to PICCs were posed. Responses were evaluated using descriptive statistics and comparisons were made using a chi-square test.
Results: Of the 2762 potential respondents who accessed the survey, 1698 (61.5%) were deemed eligible. Half of respondents (50%) reported having placed at least 1000 PICCs in their career and 60% indicated they held a vascular-access certification. Most (82.7%) reported that vascular access nurses placed the majority of PICCs at their institution. The most common reported indication for PICC insertion was intravenous antibiotics followed by difficult venous access, total parenteral nutrition and chemotherapy. Technology use was variable, with most respondents using ultrasound to find a suitable vein (85%) and estimate the catheter to vein ratio (74%), but fewer (56%) using electrocardiographic guidance for PICC placement. Notably, experienced operators (placed ≥1000 PICCs) were more likely to use all three practices (p=.0001, p=.003, p=.0001, respectively). PICC occlusion was reported as the most common complication (41%) followed by device migration (18%). The majority of respondents (92%) noted that their hospitals tracked the number of PICCs placed; however, only 62% reported tracking duration of PICC use. Nearly all (93%) respondents noted that their facility had a written policy regarding standard PICC care, and approximately one-half (55%) reported use of a nursing process that reviewed PICC necessity daily. Nonetheless, 35% of all respondents and 45% of experienced operators thought that at least 10% of PICCs placed at their facility were inappropriate.
Conclusions: This large survey of vascular access operators identifies key information regarding PICC use. One-third of vascular access providers believe that at least 10% of PICCs are placed inappropriately. In addition, formal tracking and review of PICC dwell time was variable, highlighting an area for improvement. Given increasing PICC use and related complications, this survey draws attention to an area in which improving appropriate use could benefit patient safety.