Vascular Access Specialist IU Health Ball Memorial Hospital New Madison, Ohio
Purpose: : The purpose of this evidence-based practice initiative was to implement and evaluate application of tissue adhesive to insertion sites after placement of peripherally inserted central catheters (PICC) to reduce bleeding and risk of catheter-associated blood stream infections (CLABSIs). Data from electronic medical records were collected pre-implementation and post-implementation.
Methods: : CLABSIs are avoidable harm events that result in death for 25% of patients affected. A common cause is an infection related to peripherally inserted central catheters (PICC). When bleeding occurs at a PICC insertion site, the blood creates a medium for bacterial growth. Furthermore, when bleeding occurs, nurses must replace the dressing at the PICC site, which further increases the risk of CLABSI. Dressing changes are costly both in required supplies and nurses’ time to complete. Vascular access (VA) nurses initiated the application of tissue adhesive to PICC insertion sites at the target hospital in December 2020. Data were gathered from records of inpatients with a PICC placement for five weeks pre-implementation, 60 days post-implementation, and 60 more days post-implementation
Results: : VA nurses placed 87 PICCs pre-implementation; 15 (17%) had post-insertion bleeding. In the first 60 days post-implementation, VA nurses placed 120 PICCs, 30 with tissue adhesive. Two patients with tissue adhesive had bleeding (6%); however, neither episode occurred within the one-day period of expected post-insertion bleeding. Of the 90 patients who did not receive tissue adhesive, 14 bled at the insertion site (15.5%). In the second 60 days post-implementation, VA nurses placed 115 PICCs; 84 patients received tissue adhesive. Five had bleeding post insertion (5.9%). Of the 31 patients who did not receive tissue adhesive, 12 had bleeding post-insertion (38.7%). No patients with tissue adhesive had adverse effects. No patients developed a CLABSI. Vascular access nurses readily adopted the new practice, once they received education and reviewed existing research.
Limitations:: Limitations of the evaluation with post insertion PICC placement was the relatively small sample size used. Additionally, was the bleeding secondary to aberrant coagulation issues or the result of accidental pulling on the line causing trauma at the insertion site? Those questions are yet to be answered.
Conclusions: : Application of tissue adhesive at PICCs insertion sites among inpatients can reduce bleeding, which can reduce risk of CLABSIs. While not measured in this project, cost savings increase when nurses do not have to change insertion site dressings secondary to blood accumulation. The findings from this single site study are congruent with findings of prior research and suggest that translation of evidence into practice can begin effectively with vascular access nurses who can then become champions for the new practice and support adoption among all providers who place PICCs.
