Enhancing PICC Care and Patient Outcomes: A Quality Initiative at Mosaic Life Care (2023)
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Time to read 9 min
Topic:
Assessing the Impact of Integrating Garment-Based Secondary Securement Devices into the Standard of Care for PICCs and Midlines.
Abstract:
Peripherally Inserted Central Catheters (PICCs) are crucial in patient care, particularly for those requiring long-term intravenous treatments. According to Gonzalez and Cassaro (2023), they can be managed in inpatient and outpatient settings; common indications include patients with limited peripheral access, long-term IV medication administration, and blood product infusions. However, several complications are associated with using PICCs, including infection and migration (Gonzalez & Cassaro, 2023).
Due to the structure and design of IV catheters such as PICCs and midlines, and the need for adhesive dressings as primary securements, clinicians face other challenges. These include skin breakdown, compromised dressing integrity, and patient discomfort. Patient movement, activities of daily living, and improper PICC care and maintenance exacerbate these challenges. Dressings are the first line of defense against infection and dislodgements, so they "must be kept secure, clean, dry and intact" (Borello, & Nichols, 2022).
Garment-based secondary catheter securement devices are dual-layer garments designed to cover the primary dressing and store the external lumen(s) of the catheter. If used correctly, it may help prevent medical line entanglement due to patient activity. The design also provides a barrier between the patient's skin and external tubing to help prevent skin irritation from unnecessary friction. Lastly, the design is intended to cover the primary dressing entirely to help maintain dressing integrity, prevent the need for additional tape, and guard against the user, especially in pediatrics or confused populations, from disturbing the dressing.
This Quality Initiative evaluates the impact of incorporating garment-based secondary catheter securement devices, specifically the PICCPerfect® Pro, on the care, maintenance, and satisfaction of both patients and clinicians with PICCs at three sites of Mosaic Life Care in the state of Missouri. The initiative focused on determining whether the implementation of this device could impact dressing integrity, dislodgement rates, overall patient comfort, and clinician satisfaction.
Background:
2.1 Study Design: Intervention and Control
This Quality Initiative involved a comparison between the standard of care for PICCs at three (3) sites and an intervention group, which incorporated the PICCPerfect® Pro as a garment-based secondary securement device. See details below on sites and their associated standards of care:
Site 1: Mosaic St. Joseph:
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The standard of care includes the use of:
Catheter securement device: StatLock®
Primary dressing: Cardinal Health Presource Central Line Dressing Tray Shield
Showering protocol: Saran wrap
Average PICCs placed: 20+ per month
Average PICC dwelling times: 4-12 weeks
PICC placements settings: in-patient, out-patient, and oncology
- Intervention group: 20 patients
Site 2: Mosaic Maryville:
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The standard of care includes the use of:
Catheter securement device: StatLock™ CV Plus
Primary dressing: 3M Tegaderm
Showering: AquaGuard Glove
Average PICCs placed: 5 PICCs per month
Average midlines placed: 10 per month
Average PICC dwelling times: 42 days / 6 weeks
PICC placement settings: in-patient, out-patient
Intervention Group: 15 patients
Site 3: Mosaic Albany:
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The standard of care includes the use of:
Catheter securement device: StatLock™
Primary dressing: OpSite transparent
Showering: Cover with plastic wrap or bag
Average PICCs placed: 2 PICCs per month
Average PICCs maintained: 5 per month
Average PICC dwelling times (60 days / 8.6 weeks)
PICC placement settings: in-patient, out-patient
Intervention Group: 2 patients
2.2 Data Collection
Data was collected before and after the implementation of the PICCPerfect® Pro to assess its impact on key variables, including dressing integrity, dislodgement rates, unscheduled dressing changes, and patient comfort.
The pre-implementation survey gathered baseline data on the variables under the standard of care, while the post-implementation survey captured the same indicators after introducing the PICCPerfect® Pro.
3. Results: What were the findings?
3.1 Results, Site 1: Mosaic St. Joseph
3.1.1 Improved Dressing Integrity and Reduced Dressing Changes
In the pre-implementation phase, clinicians noted that:
Dressing edges began to lift by day 3.5 on average
As the lead clinician shared, the “biggest issue we have especially during summer is dressings staying on for 7 days with sweating/warmth”.
The lead clinician also shared the need for “better dressings that stay [in place], and different cleaners for changes”, when asked for factors that would help improve the patient experience or facilitate the clinician’s job.
Post-implementation , the use of the PICCPerfect® Pro results showed:
Dressing edges began to lift by day 5 on average
Lifespan of dressings: 7 days
Preempetive/ unscheduled dressing changes: 0
3.1.2 Reduced PICC Complications
In the pre-implementation phase, clinicians noted that:
Patients who necessitated preemptive/unscheduled dressing changes: 10%
Patients who developed CLABSI/infection: 5%
PICC dislodgment rate: 1%
Post-implementation , the lead clinician reported a noticeable reduction in these issues, with:
0% of patients needing preemptive/unscheduled dressing changes
0% of CLABSI/infections addressed
0% of PICC dislogment rate
0% PICCs failing during the evaluation period.
This suggests that the PICCPerfect® Pro contributed to better overall catheter stability and maintenance.
3.1.3 Increased Patient Satisfaction
Regarding patient satisfaction variables, the pre-implementation survey indicated that:
50% of patients complained about discomfort with their line
>75% of patients expressed discomfort due to skin irritation caused by their line
50% of patients complained about pressure injury (i.e. discomfort from PICC tubing coming into contact with their skin).
After the introduction of the PICCPerfect® Pro:
>90% of patients reported improved comfortability
0% of patients expressed discomfort due to skin irritation caused by their line
100% of patients used the PICCPerfect® Pro for the entirety of their PICC treatment.
3.1.4 Increased Clinician Satisfaction & Suggestions
Regarding clinician experience, the lead clinician reported a desire to have her site carry the PICCPerfect® Pro.
One suggestion from the lead clinician to improve the visibility of the dressing when the product was on for routine assessments.
3.2 Results Site 2, Mosaic Maryville
3.2.1 Improved Dressing Integrity and Reduced Dressing Changes
In the pre-implementation phase, clinicians noted that:
Dressing edges began to lift by day 5 on average
The lead clinician shared, one of the challenges for patients being treated with PICCs, included “ itchy skin” and “ irritated/red skin”.
The lead clinician also shared the need for “ skin prep to decrease irritated skin ” and the need to [keep the site] “ dry in showers ”, when asked for factors that would help improve the patient experience or facilitate the clinician’s job.
Post-implementation , the use of the PICCPerfect® Pro results showed:
Dressing edges began to lift by day 7 on average
3.2.2 Continued low or absent rate of PICC complications
Prior to the intervention:
10% of patients necessitated preemptive/unscheduled dressing changes
0% of patients developed CLABSI/infection
0% of PICC dislogment rate
Post-intervention , the lead clinician reported the same rates of complications, with:
0% of CLABSI/infections addressed
0% of PICC dislogment rate
Given the lack of complications, one can not assume the PICCPerfect® Pro contributed to the absence of them; however, it suggests that the PICCPerfect® Pro implementation does not lead to an increase in the above-reported challenges in overall catheter stability and maintenance.
3.2.3 Increased Patient Satisfaction
Regarding patient satisfaction variables, the pre-implementation survey indicated that:
50% of patients complained about discomfort with their line
>75% of patients expressed discomfort due to skin irritation caused by their line
>75% of patients complained about pressure injury (i.e. discomfort from PICC tubing coming into contact with their skin).
After the introduction of the PICCPerfect® Pro:
100% of patients reported improved comfortability
0% of patients expressed discomfort due to skin irritation caused by their line
>90% of patients used the PICCPerfect® Pro for the entirety of their PICC treatment.
3.2.4 Increased Clinician Satisfaction & Suggestions
Regarding clinician experience, the lead clinician reported:
A desire to have her site carry the PICCPerfect® Pro at the site.
Device useful in the following settings: outpatient, oncology
-
Preferred benefits for the clinician included:
“[S]ecurement, tight on the patients, so not falling off or stretching out”.
Reported challenges using the PICCPerfect® Pro:
There were no challenges using the device by the lead clinician
Regarding usage after reading the IFU and seeing the demo:
It was easy to put on the device 100% of uses
The correct size was chosen for the patients on the first round >90%
The latter point suggests there is an area for improvement in providing more effective education or tools for clinicians on how to select the ideal size for the user.
3.3 Results Site 3, Mosaic Albany
3.3.1 Improved Dressing Integrity and Reduced Dressing Changes
In the pre-implementation phase, clinicians noted that:
Dressing edges began to lift by day 2 on average
The lead clinician shared, that one of the challenges for patients being treated with PICCs was that “ some of [their]patients are very active outdoors. Dressings come in lifted and dirty often”.
The lead clinician also shared the need for “ comfortable securement ”, when asked for factors that would help improve the patient experience or facilitate the clinician’s job.
Post-implementation , the use of the PICCPerfect® Pro results showed:
Dressing edges began to lift by day 7 on average
On average, 0% of patients got their dressing changed preemptively before the 7 days
3.3.2 Reduced complication rates
Prior to the intervention:
50% of patients necessitated preemptive/unscheduled dressing changes
0% of patients developed CLABSI/infection
10% of PICC dislogment rate
10% of PICCs failed
Post-intervention , the lead clinician reported the same rates of complications, with:
0% of patients necessitated preemptive/unscheduled dressing changes
0% of CLABSI/infections addressed
0% of PICC dislogment rate
0% PICCs failing during the evaluation period.
3.3.3 Increased Patient Satisfaction
Regarding patient satisfaction variables, the pre-implementation survey indicated that:
50% of patients complained about discomfort with their line
>75% of patients expressed discomfort due to skin irritation caused by their line
>75% of patients complained about pressure injury (i.e. discomfort from PICC tubing coming into contact with their skin).
After the introduction of the PICCPerfect® Pro:
>75% of patients reported improved comfortability
The device helped prevent the PICC/lumens from rubbing against the patient’s skin >90% of the time
>90% of patients used the PICCPerfect® Pro for the entirety of their PICC treatment.
3.3.4 Increased Clinician Satisfaction & Suggestions
Regarding clinician experience, the lead clinician reported:
A desire to have her site carry the PICCPerfect® Pro at the site.
Device useful in the following settings: outpatient, oncology
-
Preferred benefits for the clinician included:
“Patients loved the lightweight feel, more secure”
Reported challenges using the PICCPerfect® Pro:
“Top rolls down”
Regarding usage after reading the IFU and seeing the demo:
It was easy to put on the device >90% of uses
The correct size was chosen for the patients on the first round >75%
The latter point suggests there is an area for improvement in providing more effective education to clinicians on how to put on the device and how to select the ideal size for the user.
4. Conclusion & Future Implications
The quality initiative at Mosaic Life Care evaluated the integration of the PICCPerfect® Pro, a garment-based secondary securement device, across three sites to enhance PICC and midline care. Results demonstrated improved dressing integrity, with fewer incidences of dressing edges lifting and reduced need for unscheduled dressing changes, particularly at Mosaic St. Joseph and Mosaic Albany. The intervention also led to a reduction in complications such as infections, dislodgement, and catheter failure, with some sites reporting a complete elimination of these issues. Patients across all sites reported increased comfort and reduced skin irritation, leading to high acceptance and satisfaction with the device. Clinicians expressed strong support for continued use of the PICCPerfect® Pro, citing its secure fit and ease of use, though some noted minor challenges like visibility of dressings during assessments and occasional rolling of the device.
Further research with a larger patient population is recommended to validate these findings and explore the potential for even greater improvements in patient care and clinical efficiency. Future studies should explore the long-term benefits of such devices in larger populations and diverse care settings.
The positive outcomes observed in this Quality Initiative suggest that garment-based secondary securement devices like the PICCPerfect® Pro should be considered for broader implementation in healthcare settings.
References
- Gonzalez, R., & Cassaro, S. (2023, September 4). Percutaneous central catheter. In StatPearls [Internet]. StatPearls Publishing. Retrieved from NCBI.
- Borello, , E., & Nichols, L. (2022, September). The Royal Children’s hospital melbourne. The Royal Children’s Hospital Melbourne Nursing Guidelines.
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