Peripherally inserted centra! catheter complications highlight the need for ongoing support: results of a chart audit

摘要

Introduction: Since the 1940s, peripherally inserted central catheters have proved beneficial to patients and organisations, in acute and community settings. Background: Nurses within the Medical Imaging Department of an Australian regional hospital commenced insertion of peripherally inserted central catheters under ultrasound guidance in 2002. This initiative increased the number of successful insertion attempts and reduced sequelae of poorly-inserted catheters. However, medical imaging nurses raised concerns regarding the number of patients returning to the department for catheter replacements.Process: A retrospective audit of charts of patients who had a peripherally inserted central catheter over a 13-month period was undertaken. Data were collected to ascertain: the number of peripherally inserted central catheters replaced within 8 weeks of insertion; the reasons for replacement; and number of days before complications arose.Findings: Over 10% of the 575 patients who had a peripherally inserted central catheter within the time period had their catheters replaced (n = 59). Three main complications contributed to the need for line replacement: suspected infection (44%); occluded lines (23%); and securement issues such as dislodgement or accidental removal (15%). Laboratory-confirmed infections included both Gram-positive and Gram-negative organisms. The median dwell time until complication was 13 days. Outcomes: This review has identified that introducing a new service does not negate the need for ongoing support and resourcing in order to sustain low complication rates.