Additional Supporting Information may be found in the online version of this article:
Table S I. Evidence-based better practices developed by a multidisciplinary task force for PICCs care
at our centre (see references below)
Category
Specific PICCs care procedures
Hand hygiene
Hand washing with an alcohol-based “waterless” product before manipulation of catheter.
Sterile barrier
Usage of sterile material (sterile gloves, drapes, cap and mask) and chlorhexidine solutions or
chlorhexidine sponges for catheter dressings (except patient’s contraindication).
Skin preparation
Skin and PICC exit site are aseptically cleaned with 2% chlorhexidine and allow dry for 2 minutes
before manipulating
PICCs insertion
Trained nurses inserted the catheter under cardiac and respiratory monitoring and applying the
maximum sterile conditions.
Position was confirmed by chest radiography. We considered optimal if the tip was located at cavoatrial junction and acceptable anywhere in superior vena cava.
Patients were referred to intensive care unit (ICU) team when was unsuccessful placing (two
insertion attempts are allowed), or when had inadequate veins access.
PICCs maintenance
Catheters were secured to the skin with use of fixation transparent dressing and were covered with an
occlusive gauze dressing.
The dressings were replaced every 48h in hospitalized patients and every one to two weeks in
outpatients or health centre; and always when dressings became damp, loose, etc.
After each use and once weekly when not in use; were flushed using 6 ml of heparin solution (20
UI/ml).
No antibiotic prophylaxis specifically was administered because no studies have demonstrated any
reduction in CRBSI rates.
There was no routine use of thromboprophylaxis while de PICC line was in situ.
Removing the PICC as soon as the therapeutic goal has been reached or in cases of death or catheter
related complication (see text for details).
PICCs removal
Catheters were removal under aseptically conditions according to these criteria: electively (end of
therapy or completion of intensive phase of chemotherapy), death of patient, or due to related
complications.
PICCs were routinely cultured at removal.
Patients and family
education
General and detailed information about PICC hygiene and care were given (emphasized hand
hygiene).
Specific information about PICC complications and rules of procedures in case of any sign/symptoms
of complications were given.
Staff education
Educational workshops, including theoretical and practical aspects, addressed to every nurse and
physician taking care of patients were performed every year since the beginning of program.
Team PICC meetings
Discussion about PICC-related complications rates ( CRBSI, CRT, etc); possible doubts or problems
detected during the implementation of the program; as well as meetings of the group of infection
control were performed on a 3-month basis to evaluate PICC-related complication rates, adherence to
the intervention program and to discuss possible changes.
PICCs registration
All patients were examined daily or every one to two weeks in the outpatient clinic for symptoms or
signs suggestive of any complications while PICC was still in place.
Incidences happened were registered by nursery and leaders physicians’ team.
PICC- peripheral inserted central catheter, CRBSI- catheter related bloodstream infection, CRT- catheter related
thrombosis.
References
1.
2.
O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA,
Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S, Healthcare
Infection Control Practices Advisory Committee (HICPAC). (2011) Guidelines for the
prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52,
e162-93.
Alexander M. (2011). The new gold standard in infusion nursing. Journal of Infusion
Nursing, 34(1), 11.
3.
Maki DG, Weise CE, Sarafin HW. (1977) A semiquantitative culture method for
identifying intravenous- catheter-related infection. New England Journal of Medicine,
296(23), 1305-9.
4.
Ljungman P, Hägglund H, Björkstrand B, Lönnqvist B, Ringdén O. (1997) Peroperative
teicoplanin for prevention of gram-positive infections in neutropenic patients with
indwelling central venous catheters: a randomized, controlled study. Support Care Cancer,
(6), 485-8.
5.
Jeffries HE, Mason W, Brewer M, Oakes KL, Muñoz EI, Gornick W, Flowers LD, Mullen
JE, Gilliam CH, Fustar S, Thurm CW, Logsdon T, Jarvis WR.(2009) Prevention of central
venous catheter-associated bloodstream infections in pediatric intensive care units: a
performance improvement collaborative. Infection Control and Hospital Epidemiology, (7),
645-51.
6.
Møller T, Borregaard N, Tvede M, Adamsen L. (2005). Patient education-a strategy for
prevention of infections caused by permanent central venous catheters in patients with
haematological malignancies: a randomized clinical trial. Journal of Hospital Infection, (4),
330-41.
7.
Pascual A., Bouza E., Liñares J. (2004) Procedimientos en Microbiología Clínica.
Recomendaciones de la Sociedad Española de Enfermedades Infecciosas y Microbiología
Clínica.