Implementering av PICC-line – en kvalitativ studie av anestesisykepleieres erfaringer

PICC-line, a peripherally inserted central venous catheter has been implemented by several Norwegian hospitals in recent years. Nurse Anesthetists play an important role in this process, and have been given new tasks as a result of PICC-line implementation. This study aimed to describe Nurse Anesthetists’ experiences with implementation of PICC-line in hospital. A qualitative design, the data are based on three focus groups interviews with fifteen nurse anesthetists. The interviews were analyzed using a hermeneutic approach. Being a PICC-line nurse led to a feeling of competence, independence, motivation and meaningfulness. The implementation required good structure and organization, as well as enthusiasm. Collaboration and support influenced the implementation process. Good organization and enough available personnel, as well as good collaboration and support from the Anesthesiologists and the management are essential for a successful implementation.

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Implementation of ultrasound after central venous catheter insertion: A qualitative study in early adopters

The Journal of Vascular Access ◽

10.1177/11297298211053447 ◽

2021 ◽

pp. 112972982110534

Author(s):

Enyo A Ablordeppey ◽

Shannon M Keating ◽

Katherine M Brown ◽

Daniel L Theodoro ◽

Richard T Griffey ◽

...

Keyword(s):

Focus Group ◽

Central Venous Catheter ◽

Qualitative Analysis ◽

Focus Groups ◽

Venous Catheter ◽

Barriers And Facilitators ◽

Central Venous ◽

Focus Group Discussions ◽

Group Discussions ◽

Post Procedure

Background: The adoption rate of point of care ultrasound (POCUS) for the confirmation of central venous catheter (CVC) positioning and exclusion of post procedure pneumothorax is low despite advantages in workflow compared to traditional chest X-ray (CXR). To explore why, we convened focus groups to address barriers and facilitators of implementation for POCUS guided CVC confirmation and de-implementation of post-procedure CXR. Methods: We conducted focus groups with emergency medicine and critical care providers to discuss current practices in POCUS for CVC confirmation. The semi-structured focus group interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach (NVivo software), aiming to identify priority categories that describe the barriers and facilitators of POCUS guided CVC confirmation. Results: The coding dictionary of barriers and facilitators consisted of 21 codes from the focus group discussions. Our qualitative analysis revealed that 12 codes emerged spontaneously (inductively) within the focus group discussions and aligned directly to CFIR constructs. Common barriers included provider influences (e.g. knowledge and beliefs about POCUS for CVC confirmation), external network (e.g. societal guidelines, ancillary staff, and consultants), and inertia (habit or reflexive processes). Common facilitators included ultrasound protocol advantage and champions. Time and provider outcomes (cognitive offload, ownership, and independence) emerged as early barriers but late facilitators. Conclusion: Our qualitative analysis demonstrates real and perceived barriers against implementation of POCUS for CVC position confirmation and pneumothorax exclusion. Our findings discovered organizational and personal constructs that will inform development of multifaceted strategies toward implementation of POCUS after CVC insertion.

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Brachial Arteriovenous Fistula as a Complication of Placement of a Peripherally Inserted Central Venous Catheter: A Case Report and Review of the Literature

The American Surgeon ◽

10.1177/000313480607200914 ◽

2006 ◽

Vol 72 (9) ◽

pp. 833-836 ◽

Cited By ~ 2

Author(s):

Hoang S. Tran ◽

Brian J. Burrows ◽

William A. Zang ◽

David C. Han

Keyword(s):

Central Venous Catheter ◽

Arteriovenous Fistula ◽

Duplex Ultrasound ◽

Venous Catheter ◽

Central Venous ◽

Arterial Tree ◽

Line Placement ◽

Term Administration ◽

History Of ◽

Picc Line

Peripherally inserted central venous catheter (PICC) lines have become a frequently used method of intravenous access for long-term administration of antibiotics, chemotherapy, and parenteral nutrition. Catheter-related complications involving the arterial tree are rare. We report a case of a 25-year-old woman with a history of difficult PICC line placement that presented with an arteriovenous fistula in the left arm. Duplex ultrasound confirmed the diagnosis of a brachial artery-to-brachial vein arteriovenous fistula (AVF), and the patient underwent surgical repair. To our knowledge, this is the first reported case of an AVF resulting from PICC line placement. Correction of AVF is indicated to alleviate symptoms as well as to prevent future complications.

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A trial comparing central venous catheter (CVC) and peripherally inserted central venous catheter (PICC) line central venous catheter

http://isrctn.org/> ◽

10.1186/isrctn70648637 ◽

2013 ◽

Author(s):

Cecilia Engström

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous ◽

Picc Line

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Study Protocol for Draup: De-implementation Ofroutine Chest Radiographs After Adoption of Ultrasound Guided Insertion and Confirmation of Central Venous Catheter Protocol, A Hybrid Implementation/effectiveness Study

10.21203/rs.3.rs-37859/v1 ◽

2020 ◽

Author(s):

Enyo A. Ablordeppey ◽

Byron J. Powell ◽

Virginia R. McKay ◽

Shannon M. Keating ◽

Aimee S. James ◽

...

Keyword(s):

Central Venous Catheter ◽

Focus Groups ◽

Imaging Modality ◽

Point Of Care ◽

Implementation Strategies ◽

Venous Catheter ◽

Point Of Care Ultrasound ◽

Central Venous ◽

Medical Overuse ◽

Chest X Ray

Abstract BACKGROUNDAvoiding low value medical practices is an important focus in current healthcare utilization. Despite advantages of point of care ultrasound (POCUS) over chest x-ray (CXR), including improved workflow and timeliness of results, POCUS-guided central venous catheter (CVC) position confirmation and exclusion of pneumothorax (PCEP) has had slow rate of adoption. This demonstrates a gap that is ripe for the development and application of de-implementation strategies that support substitution of POCUS for CXR after CVC insertion.METHODSDe-implementation of routine chest radiographs after adoption of ultrasound guided insertion and confirmation of central venous catheter protocol (DRAUP) will be created to de-implement an unnecessary imaging modality in the critical care environment. Guided by the Consolidated Framework for Implementation Research constructs, we will explore barriers and facilitators of POCUS for CVC PCEP in a single center, large tertiary, academic hospital via focus groups. The focus groups will inform the development and testing of strategies that address identified determinants of implementation and de-implementation.Operational use of the de-implementation strategies will be conceptualized using Morgan’s framework for understanding and reducing medical overuse. We will locally implement these strategies and assess them using Proctor’s outcomes (adoption, de-adoption, fidelity and penetration) in an observational study to demonstrate proof of concept, gaining valuable insights on our selected implementation and de-implementation strategies. Secondary outcomes will include POCUS-guided CVC PCEP efficacy measured by time and effectiveness measured by sensitivity and specificity of POCUS detection.DISCUSSIONWith limited data available to inform interventions that use concurrent implementation and de-implementation strategies to substitute CXR for POCUS using DRAUP, we propose that this primary implementation and secondary effectiveness pilot study will provide novel data that would expand the knowledge of replacing low value or unnecessary care in critically ill patients. Trial Registration: ClinicalTrials.gov Identifier, NCT04324762, Registered on 27 March 2020

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Establishing a Nurse-Led Central Venous Catheter Insertion Service

Journal of the Association for Vascular Access ◽

10.2309/java.15-1-5 ◽

2010 ◽

Vol 15 (1) ◽

pp. 21-27 ◽

Cited By ~ 13

Author(s):

Evan Alexandrou ◽

Tim Spencer ◽

Steven A. Frost ◽

Michael Parr ◽

Patricia M. Davidson ◽

...

Keyword(s):

Central Venous Catheter ◽

Best Practice ◽

Evaluation Method ◽

Central Venous Access ◽

Venous Catheter ◽

Venous Access ◽

Successful Implementation ◽

Medical Procedure ◽

Central Venous ◽

Medical Practitioners

Abstract Background: Health care systems promote care models that deliver both safety and quality. Nurse-led vascular access teams show promise as a model to achieve hospital efficiencies and improve patient outcomes. Objectives: The aim of this paper is to discuss the process of establishing a nurse-led central venous catheter (CVC) insertion service in a university affiliated hospital using a process evaluation method. Method: Archival information, including reports, communications and minutes of departmental meetings were reviewed. Key stakeholders involved in establishing this nurse-led service at the time were interviewed. Results: A nurse-led CVC insertion service was first established in 1996 and has increased in service provision over 13 years. Initially there was scepticism from some medical practitioners about the feasibility of a nurse performing a traditional medical procedure. The service currently provides central venous access across the hospital including critical care areas. The service places up to 500 catheters per annum. Conclusions: Establishing a nurse-led CVC insertion service has increased organizational efficiencies and provided an infrastructure for support of best practice. The support of senior management and medical practitioners was crucial to the successful implementation of this model of care.

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