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The importance of vascular access device selection : case study
Interviews were conducted to characterise two healthcare practitioners ’ adoption of peripherally inserted central catheters into their clinical practices and the resulting clinical and economic benefits associated with their use
Disclaimer This case study reflects the individual experiences of two healthcare practitioners and does not represent a scientific study or present clinical evidence . Results for other clinicians or institutions will vary . Please consult manufacturer ’ s instructions for use for relevant warnings , indications , and counterindications .
Disclosure This hospital experience report was sponsored by Becton , Dickinson and Company . FP is an employee of Careggi University Hospital and NCR is an employee of University Hospital of La Coruña . CC is an Engagement Manager for Trinity Partners , LLC , contracted by Becton , Dickinson and Company to conduct the interviews and write the report .
Most hospitalised patients receive some form of vascular access during their hospital stay . 1 With a variety of options of vascular access devices ( VADs ) to choose from , selecting the appropriate VAD is an important part of patient care . VAD selection should be tailored to each patient ’ s needs , taking into account the length of therapy , number of lumens required , flow rates required , need for blood draws , patient preference , and whether or not the patient will be discharged on therapy . 2 One important VAD option is peripherally inserted central catheters ( PICCs ). Technological advances in PICCs over the last several years have introduced a variety of benefits that have resulted in their increased utilisation . PICCs can be utilised for both short- and long-term access to the central venous system . Clinicians have found many uses for PICCs including administration of intravenous therapy ( such as antibiotics , total parenteral nutrition , and chemotherapy ), power injection of contrast media , central venous pressure monitoring , and blood sampling . 3 Interviews with Dr Fulvio Pinelli and nurse Noemí Cortes Ray were conducted to characterise two healthcare practitioners ’ adoption of PICCs into their clinical practices and the resulting clinical and economic benefits associated with their use .
Oncology use in Italy Dr Fulvio Pinelli is an anesthesiologist at Careggi University Hospital , a large university hospital in Firenze , Italy . He splits his time between the oncology department and the vascular access centre . Most of his VAD patients are oncology patients receiving chemotherapy . Pinelli estimates that the vascular access team at his hospital places approximately 2500 VADs annually . Over the past several years PICC use has increased in Pinelli ’ s hospital . In his opinion , this is largely due to advances in PICC technology and increasing awareness amongst physicians of PICC applicability in the medium-term setting , spanning from days to a few months .
According to Pinelli , three key technological advances have driven PICC adoption in Pinelli ’ s hospital : the introduction of multi-lumen PICCs , improvements in PICC construction materials , and the development of PICCs that allow for PICC placement at the bedside without radiology . Multi-lumen PICCs have removed a significant barrier to PICC use by allowing simultaneous perfusion and haemodynamic monitoring . “ In the past , for intensivists , PICCs were not an option
24 HHE 2018 | hospitalhealthcare . com because they were single-lumen , had reduced catheter flow rates , and you either couldn ’ t do haemodynamic monitoring or it was a timeconsuming procedure . But then the design improved . Now we have 2 – 3 lumen PICCs . Materials used to construct PICCs have also had a large impact . It ’ s now polyurethane , so the devices soften in the body , have very good strength and pliability . The other major improvement is power injectability . These [ technological advances ] all led to the possibility of high flows ( versus silicone PICCs and non-power PICCs ), multiple infusions , and the possibility of giving contrast media .”
The development of PICCs that use the patient ’ s cardiac electrical activity to guide placement has also been a significant improvement for Pinelli ’ s hospital . Pinelli ’ s hospital uses Becton , Dickinson and Company ’ s Sherlock 3CG™ , which utilises an adult patient ’ s cardiac electrical activity to position the tip of the PICC in close proximity to the cavoatrial junction ( CAJ ). Historical practice at Pinelli ’ s hospital had been to insert PICCs “ blind ” without real-time tip location visualisation . 4 Now Pinelli and colleagues are able to use real-time catheter tip tracking technology to display both catheter direction and orientation , checking to confirm tip termination during the procedure . Pinelli reports that with this technique , “ successful placement rate has been shown to be around 99 %”. 5
Altogether , Pinelli reports that these advances have spurred him to , “… spread this culture , to convince even the most reluctant doctors to think about using PICCs in hospital patients .”
ICU use in Spain Noemí Cortés is a nurse working in a large intensive care unit ( ICU ) within University Hospital of La Coruña , a public university hospital in northwest Spain . Patients in Cortés ’ unit are post-surgical critical care patients who come to the ICU after surgery , usually with a centrally inserted central catheter ( CICC ) from the operating room .
Cortés is a strong proponent of PICCs and has been a champion of PICC adoption in her hospital system . The evolution of PICC adoption in Cortés ’ ICU has been driven by nurses , and the nurses are exclusively the personnel to place PICCs .
Until a few years ago , the vast majority of VADs placed in Cortés ’ ICU were CICCs . PICC use was rare , requiring placement by the hospital ’ s radiology team . When Cortés joined the ICU