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CE: Original Research Does Certification in Vascular Access Matter? An Analysis of the PICC1 Survey

Chopra, Vineet MD; Kuhn, Latoya MPH; Vaughn, Valerie MD; Ratz, David MS; Winter, Suzanne MS; Moureau, Nancy PhD, RN; Meyer, Britt PhD, RN; Krein, Sarah PhD, RN

AJN The American Journal of Nursing: December 2017 - Volume 117 - Issue 12 - p 24–34
doi: 10.1097/01.NAJ.0000527458.85599.3a
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Background: Although certification by an accredited agency is often a practice prerequisite in health care, it is not required of vascular access specialists who insert peripherally inserted central catheters (PICCs). Whether certification is associated with differences in practice among inserters is unknown.

Purpose: The purpose of this study was to gather information regarding whether certified and noncertified PICC inserters differ with respect to their practices and views about PICC use.

Methods: We conducted a national survey of vascular access specialists, identifying certified PICC inserters as those who had received board certification from the Association for Vascular Access, the Infusion Nurses Society, or both. The 76-item survey asked about PICC policies and procedures at respondents’ facilities, use of insertion technologies, device management, management of complications, perceptions about PICC use, and relationships with other health care providers. Additional data about respondents, including years in practice and primary practice settings, were also gathered. Bivariable comparisons were made using χ2 tests; two-sided α with P ≤ 0.05 was considered statistically significant.

Results: Of the 1,450 respondents in the final sample, 1,007 (69%) said they were certified inserters and 443 (31%) said they were not. Significantly higher percentages of certified than noncertified inserters reported having practiced for five or more years (78% versus 54%) and having placed 1,000 or more PICCs (58% versus 32%). Significantly more certified than noncertified inserters also reported being the vascular access lead for their facility (56% versus 44%). Reported practice patterns for insertion, care, and management of PICCs varied based on certification status. Some evidence-based practices (such as the use of ultrasound to measure catheter-to-vein ratios) were more often reported by certified inserters, while others (such as the use of maximal sterile barriers during PICC insertion) were not. Asked about their perceptions of PICC use at their institution, certified inserters reported higher percentages of inappropriate insertion and removal than noncertified inserters.

Conclusion: Certified PICC inserters appear to be a distinct group of vascular access specialists. A better understanding of how and why practices differ between certified and noncertified inserters is necessary to ensuring safer, high-quality patient care.

Although certification by an accredited agency is often a practice prerequisite in health care, it is not required of vascular access specialists who insert peripherally inserted central catheters (PICCs). The authors of this study explored whether and how certified and noncertified PICC inserters differ regarding their practices and views about PICC use.

Vineet Chopra is an associate professor of medicine at the University of Michigan Medical School in Ann Arbor, where Valerie Vaughn is a clinical instructor and Suzanne Winter is a project manager. Latoya Kuhn is a project manager in the U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, where David Ratz is a research specialist and Sarah Krein is a research scientist. Nancy Moureau is the chief executive officer of PICC Excellence, Inc., in Hartwell, GA. Britt Meyer is an RN on the vascular access team at Duke University Medical Center in Durham, NC. Funding for this study was provided by the Agency for Healthcare Research and Quality (grant no. 1-K08HS022835-01), the VA, and the Blue Cross Blue Shield of Michigan Foundation (grant no. 2140.II). These funding agencies played no role in study design, data acquisition, data analysis, or data reporting. Krein is the recipient of a VA Health Services Research and Development Research Career Scientist Award (RCS 11-222). Moureau serves as a speaker and consultant for 3M, Access Scientific, AngioDynamics, Teleflex, BD Carefusion, Chiesi, Cook Medical, Entrotech, Fresenius Kabi, and Nexus; as a researcher at Griffith University in Queensland, Australia, she received grants from 3M, Cook Medical, and Entrotech. Meyer is an adviser on Smiths Medical's nurse advisory panel and has given expert testimony on behalf of Cooper and Scully PC. Contact author: Vineet Chopra, vineetc@umich.edu. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.

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