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Development and Implementation of a Bedside Peripherally Inserted Central Catheter Service in a PICU*

Conlon, Thomas W., MD1; Himebauch, Adam S., MD; Cahill, Anne Marie, MD1,2; Kraus, Blair M., RN, MSN1; Madu, Chinonyerem R., MPH1; Weber, Mark D., RN, CRNP-AC3; Czajka, Carol A., RN4; Baker, Ruby L., RN4; Brinkley, Torron M., RN4; Washington, Melanie D., RN4; Frey, Anne Marie, RN4; Nelson, Eileen M., RN3; Jefferies, Cara T., MSN, RN, CCRN4; Woods-Hill, Charlotte Z., MD1; Wolfe, Heather A., MD, MSHP1; Davis, Daniela H., MD, MSCE1

Pediatric Critical Care Medicine: January 2019 - Volume 20 - Issue 1 - p 71–78
doi: 10.1097/PCC.0000000000001739
Quality and Safety
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Objectives: To create a bedside peripherally inserted central catheter service to increase placement of bedside peripherally inserted central catheter in PICU patients.

Design: Two-phase observational, pre-post design.

Setting: Single-center quaternary noncardiac PICU.

Patients: All patients admitted to the PICU.

Interventions: From June 1, 2015, to May 31, 2017, a bedside peripherally inserted central catheter service team was created (phase I) and expanded (phase II) as part of a quality improvement initiative. A multidisciplinary team developed a PICU peripherally inserted central catheter evaluation tool to identify amenable patients and to suggest location and provider for procedure performance. Outcome, process, and balancing metrics were evaluated.

Measurements and Main Results: Bedside peripherally inserted central catheter service placed 130 of 493 peripherally inserted central catheter (26%) resulting in 2,447 hospital central catheter days. A shift in bedside peripherally inserted central catheter centerline proportion occurred during both phases. Median time from order to catheter placement was reduced for peripherally inserted central catheters placed by bedside peripherally inserted central catheter service compared with placement in interventional radiology (6 hr [interquartile range, 2–23 hr] vs 34 hr [interquartile range, 19–61 hr]; p < 0.001). Successful access was achieved by bedside peripherally inserted central catheter service providers in 96% of patients with central tip position in 97%. Bedside peripherally inserted central catheter service central line-associated bloodstream infection and venous thromboembolism rates were similar to rates for peripherally inserted central catheters placed in interventional radiology (all central line-associated bloodstream infection, 1.23 vs 2.18; p = 0.37 and venous thromboembolism, 1.63 vs 1.57; p = 0.91). Peripherally inserted central catheters in PICU patients had reduced in-hospital venous thromboembolism rate compared with PICU temporary catheter in PICU rate (1.59 vs 5.36; p < 0.001).

Conclusions: Bedside peripherally inserted central catheter service implementation increased bedside peripherally inserted central catheter placement and employed a patient-centered and timely process. Balancing metrics including central line-associated bloodstream infection and venous thromboembolism rates were not significantly different between peripherally inserted central catheters placed by bedside peripherally inserted central catheter service and those placed in interventional radiology.

1Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA.

2Department of Radiology, The Children’s Hospital of Philadelphia, Philadelphia, PA.

3Department of Nursing-Critical Care, The Children’s Hospital of Philadelphia, Philadelphia, PA.

4Department of Nursing-Imaging, The Children’s Hospital of Philadelphia, Philadelphia, PA.

*See also p. 86.

Drs. Conlon and Himebauch received funding from the Society of Critical Care Medicine (SCCM) for travel/lodging for SCCM-sponsored ultrasound courses. Dr. Woods-Hill received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: conlont@email.chop.edu

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies