Feeling Confident in Using PICC Lines

Abstract

Treatments involving chemotherapy require central venous access, such as a Peripherally Inserted Central (PICC) line. The aim of the study was to describe patients' experiences of living with a PICC line during chemotherapy treatment. The study comprised interviews with 10 patients and was analyzed using manifest qualitative content analysis. The categories The importance of security, The importance of contentedness, and Feeling confident in using the PICC line were identified. To contribute to patient safety and empowerment in health care, nurses must be well trained in PICC line care. Therefore, evidence-based knowledge about central venous access is necessary for patients' security and contentedness and to improve quality of care and increase patients' well-being in central venous access care activities in the future.

Peripheral Venipuncture: Comprehension and Evaluation of Nursing Practices

“…The benefits of using PICC in nursing practices in the investigated service are corroborated in other studies. 13,16,20 The number of venipuncture attempts for catheter insertion and blood collection for exams is one of the quality indicators and evidences patient satisfaction, since it has an impact at the sensorial level. 13,20,35 Therefore, PICC insertion should be guided by venous ultrasonography under local anesthesia and by a nurse who has participated in qualification courses and presents competences to perform this procedure, which contributes to better visualization of the veins and reduces the difficulty of venipuncture, and consequently the number of venipuncture attempts and pain.…”

“…13,16,20 The number of venipuncture attempts for catheter insertion and blood collection for exams is one of the quality indicators and evidences patient satisfaction, since it has an impact at the sensorial level. 13,20,35 Therefore, PICC insertion should be guided by venous ultrasonography under local anesthesia and by a nurse who has participated in qualification courses and presents competences to perform this procedure, which contributes to better visualization of the veins and reduces the difficulty of venipuncture, and consequently the number of venipuncture attempts and pain. [33][34][41][42] The use of an imaging method (venous ultrasonography) prior to PICC insertion allows the determination of the ideal insertion zone -green zone -(Zone Insertion Method-ZIM), 41 the caliber of the vein and the selection of the caliber of the PICC compatible with the caliber of the vein (preferably 1/3 of the caliber of the vein), thus reducing insertion complications (such as transfixation of the vein and difficulty in progressing the catheter) and post-insertion (such as phlebitis and venous thromboembolism).…”

“…[5][6][7] However, the evidence indicates high incidence of local complications with PVC after insertion, principally phlebitis and infiltration, as well as associated risk factors, such as irritant medications. [7][8][9][10][11][12] The peripherally inserted central venous catheter (PICC) presents as an alternative to the PVC, as it allows the administration of any type of medication, including irritants and/or vesicants, [13][14] due to the final location of its tip in a central vein. Such positioning contributes to low rates of local complications compared to PVCs and midlines.…”

“…[14][15][16][17][18] PICC have a high insertion success rate (up to 95%), especially when guided by ultrasound, 14 are cost-effective in relation to the other central venous catheters, mainly in the insertion, and have lower incidences of complications, 19 In addition, they meets patients' intravenous therapy needs, who express satisfaction and comfort during its use, particularly when the PICC is compared to the PVC, as it reduces pain related to successive venipuncture attempts. 13,[19][20] Despite the benefits, PICC limit some of the patient's daily life activities, such as the practice of water sports, and requires particular care during personal hygiene as to avoid wetting the dressing, in addition to weekly dressing changes. 13 The nurse is responsible for the clinical and holistic evaluation of the patient with a PVC, in a dynamic energy system perspective and interaction of intra, inter and extrapersonal variables.…”

“…13,[19][20] Despite the benefits, PICC limit some of the patient's daily life activities, such as the practice of water sports, and requires particular care during personal hygiene as to avoid wetting the dressing, in addition to weekly dressing changes. 13 The nurse is responsible for the clinical and holistic evaluation of the patient with a PVC, in a dynamic energy system perspective and interaction of intra, inter and extrapersonal variables. Its performance, according to the Neuman Systems Model, which aims to identify the possible stressors and their effects when a break in the defense line occurs.…”