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Problem
We observed a high (5 out of 7 lines, 70%) rate of PICC blockages on the Trauma and Orthopaedics Ward over a two month period. This led to compromised patient care by delaying drug administration and blood sampling whilst alternative intravenous access was obtained. Blockages were also associated with reduced patient satisfaction, as patients suffered with complications associated with delayed treatment. The cost of treatment increased with the need to replace the PICC. PICC blockages were considered to be time consuming for staff and distracting from other daily duties. Some of the PICCs were blocking repeatedly which was very frustrating for both the staff and patients.
To identify the contributing factors we compared current practice against the local and manufacturer's guidelines and found considerable deviation from guidelines. The following problems were identified:
1. Long and contradictory PICC care guidelines which were difficult to find2. Lack of information sheets provided in the notes of patients who had a PICC inserted3. Lack of documentation and accountability regarding flushing PICCs4. Lack of training and awareness of ward staff regarding care of PICCs
Background
PICCs are Peripherally Inserted Central Catheters used in patients requiring long term venous access. They may be safer than conventional central lines and can stay in-situ for longer. Indications for use include administration of long term antibiotics, chemotherapy, or total parenteral nutrition (TPN). As with other types of lines, PICCs are subject to complications.
The literature surrounding PICC blockage in the adult population is scarce. The majority of research concentrates on neonatal and paediatric practice, where complications associated with PICCs are well recognised. Barrier et al (1) reported that in their study of an immunocompetent paediatric population, more than 30% of PICCs developed at least one complication. A neonatal intensive care study undertaken by McCoy et al (2) looked at 1148 PICCs. 164 (14%) of these lines were replaced, either because of blockage, or migration of the line.
Baseline Measurement
We sampled all inpatients with indwelling PICCs over a period of two months on the Trauma & Orthopaedics (T&O) ward where we were working as Foundation Year 1 Doctors. Five out of the seven (70%) patients with PICCs in situ were affected by line blockage; some on multiple occasions. There was no formal...