Health Services Research & Development

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IIR 15-313 – HSR&D Study

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IIR 15-313
Understanding Use of Peripherally Inserted Central Catheters (PICCS): System, Provider, Patient Perspectives
Sarah L. Krein PhD RN
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: May 2018 - April 2020

BACKGROUND/RATIONALE:
Use of peripherally inserted central catheters (PICCs) for intravenous antibiotics, infusion of chemotherapy or total parenteral nutrition has grown substantially in hospitalized patients. Despite such growth, little is known about PICC use, practices or appropriateness in the Veterans Health Administration (VHA).

OBJECTIVE(S):
The overarching goal of this study is to provide critical data to inform the development of targeted interventions and implementation strategies to enhance PICC safety across the VA healthcare system. Specifically, the aim of this study is to identify factors that influence PICC use, care and management via interviews of vascular access and bedside nurses, radiologists, hospitalists, physician trainees, and other key staff at purposefully selected sites to inform development of robust interventions and implementation strategies for improving PICC use and care across VHA.

METHODS:
Using a primarily qualitative design, we will assess system-, provider- and patient- factors related to PICC use at 5 VHA sites with different arrangements (on-site vs. referral) for PICC placement and types of professionals (vascular nurses, interventional radiologists) that insert PICCs. We will conduct semi-structured interviews with providers and operators involved in PICC insertions (e.g., vascular access nurses, interventional radiology), to elicit opinions, practices, and experiences related to PICCs. We will also interview providers involved with decisions about PICC placement (e.g., hospitalists, physician trainees, surgeons, subspecialists such as infectious disease physicians) as well as device care and maintenance, including bedside nurses and nurse managers. Interviews will be conducted using an interview guide developed for this study, which was constructed based in part on a conceptual framework derived from the Systems Engineering Initiative for Patient Safety model, focusing on person, tools, technologies, organization factors, work processes and reported outcomes. Our analysis will be guided in part by our conceptual framework but will also incorporate new information and insights derived directly from the interview and field note data.

FINDINGS/RESULTS:
No findings to report

IMPACT:
Our analysis of interview data together with previously developed guidelines that define appropriate versus inappropriate use of PICCs will inform our development of interventions to enhance PICC safety across the VHA. In addition to suggesting the types of interventions that might be most effective at various sites, our qualitative data will also provide key information to inform potential strategies for implementing these interventions across the VHA.

PUBLICATIONS:
None at this time.


DRA: none
DRE: TRL - Applied/Translational
Keywords: none
MeSH Terms: none