“With a PICC line, you never miss”: The role of peripherally inserted central catheters in hospital care for people living with HIV/HCV who use drugs

Guţă, Adrian; Perri, Melissa; Strike, Carol; Gagnon, Marilou; Carusone, Soo Chan

doi:10.1016/j.drugpo.2021.103438

Cited by 11 publications

(7 citation statements)

References 62 publications

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“…This study supports recent research that suggests hospital policies regarding the use of PICC lines in hospitalized PWID are inadequate and that the integration of harm reduction strategies into clinical care is needed [31]. However, this study used a subset of data from a broader mixed-method evaluation that elicited the perspectives of inpatients who reported recent or active injection drug use to a harm reduction addiction medicine consultation team and who were offered sterile injection supplies at the bedside (most participants accepted those supplies).…”

Section: Strengths and Limitationssupporting

confidence: 88%

“…Three case studies have similarly described non-hospitalized people injecting into VADs, including a cannula self-inserted into a femoral vein [28], a central venous catheter [29], and a port-a-cath [30]. A recent Canadian qualitative study [31] examined the practice of injecting into PICC lines, a common type of vascular access device. Through retrospective interviews with 24 people who use drugs living with HIV/HCV who had been hospitalized at least once in the past 5 years and 26 healthcare providers, the authors found that even though few participants reported engaging in this practice, healthcare providers reported that fears of PICC line tampering influenced clinical care decision-making.…”

mentioning

confidence: 99%

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“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

et al. 2022

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Background Hospital patients who use drugs may require prolonged parenteral antimicrobial therapy administered through a vascular access device (VAD). Clinicians’ concerns that patients may inject drugs into these devices are well documented. However, the perspectives of patients on VAD injecting are not well described, hindering the development of informed clinical guidance. This study was conducted to elicit inpatient perspectives on the practice of injecting drugs into VADs and to propose strategies to reduce associated harms. Methods Researchers conducted a focused ethnography and completed semi-structured interviews with 25 inpatients at a large tertiary hospital in Western Canada that experiences a high rate of drug-related presentations annually. Results A few participants reported injecting into their VAD at least once, and nearly all had heard of the practice. The primary reason for injecting into a VAD was easier venous access since many participants had experienced significant vein damage from injection drug use. Several participants recognized the risks associated with injecting into VADs, and either refrained from the practice or took steps to maintain their devices while using them to inject drugs. Others were uncertain how the devices functioned and were unaware of potential harms. Conclusions VADs are important for facilitating completion of parenteral antimicrobial therapy and for other medically necessary care. Prematurely discharging patients who inject into their VAD from hospital, or discontinuing or modifying therapy, results in inequitable access to health care for a structurally vulnerable patient population. Our findings demonstrate a need for healthcare provider education and non-stigmatizing clinical interventions to reduce potential harms associated with VAD injecting. Those interventions could include providing access to specialized pain and withdrawal management, opioid agonist treatment, and harm reduction services, including safer drug use education to reduce or prevent complications from injecting drugs into VADs.

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Section: Strengths and Limitationssupporting

confidence: 88%

mentioning

confidence: 99%

“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

et al. 2022

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“…There are now several studies showing that PICCs are safe in a subset of PWID, especially people with stable housing and those receiving medications for opioid use disorder (OUD), which are proven to reduce all-cause and opioid-related mortality [ 25–31 ]. There are data showing that a subset of people inject drugs through their PICC, but often this is in the situation of suboptimal addiction management [ 32 ]. However, there is evidence that PICCs help support healthcare in PWID [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are data showing that a subset of people inject drugs through their PICC, but often this is in the situation of suboptimal addiction management [ 32 ]. However, there is evidence that PICCs help support healthcare in PWID [ 32 ]. Some of the perceived conflicts surrounding the care of PWID involves difficulty with vein access and appropriate pain management.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this evidence, several stakeholders in the PICC decision making process felt underprepared to care with PWID, and believed there were not clear guidelines. Augmented training programs may help support clinicians working with this unique patient population [ 18 , 32 ]. Nurses’ voices have largely been missing from this research [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

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“They Just Assume That We’re All Going to Do the Wrong Thing With It. It’s Just Not True”: Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs

Morales

Smyth

Zubiago

et al. 2022

Open Forum Infectious Diseases

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Background In the absence of adequate harm reduction opportunities, people who inject drugs (PWID) are at increased risk for serious infections. Infectious diseases guidelines recommend extended periods of intravenous antibiotic treatment through peripherally inserted central catheters (PICCs), but PWID are often deemed unsuitable for this treatment. We conducted semi-structured interviews and focus groups to understand the perspectives and opinions of patients and clinicians on the use of PICCs for PWID. Methods We approached patients and clinicians (doctors, nurses, PICC nurses, social workers, and case workers) involved in patient care at Tufts Medical Center (Boston, Massachusetts) between August 2019 and April 2020 for semi-structured interviews and focus groups. Results Eleven of 14 (79%) patients agreed to participate in an in-depth interview, and 5 role-specific clinician focus groups (1 group consisting of infectious diseases, internal medicine, and addiction psychiatry doctors, 2 separate groups of floor nurses, 1 group of PICC nurses, and 1 group of social workers) were completed. Emergent themes included the overall agreement that PICCs improve healthcare, patients’ feelings that their stage of recovery from addiction was not taken into consideration, and clinicians’ anecdotal negative experiences driving decisions on PICCs. Conclusions When analyzed together, the experiences of PWID and clinicians shed light on ways the healthcare system can improve the quality of care for PWID hospitalized for infections. Further research is needed to develop a system of person-centered care for PWID that meets the specific needs of patients and improves the relationship between them and the healthcare system.

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Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs

Grebely

Collins

Artenie

et al. 2021

International Journal of Drug Policy

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“With a PICC line, you never miss”: The role of peripherally inserted central catheters in hospital care for people living with HIV/HCV who use drugs

Cited by 11 publications

References 62 publications

“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

“I have such a hard time hitting myself, I thought it’d be easier”: perspectives of hospitalized patients on injecting drugs into vascular access devices

“They Just Assume That We’re All Going to Do the Wrong Thing With It. It’s Just Not True”: Stakeholder Perspectives About Peripherally Inserted Central Catheters in People Who Inject Drugs

Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs

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