UNDERSTANDING USE OF PERIPHERALLY INSERTED CENTRAL CATHETERS (PICCS): SYSTEM, PROVIDER, PATIENT PERSPECTIVES
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This project seeks to understand patterns of use, practices and patient views regarding peripherally inserted central catheters (or PICCs). The use of PICCs is growing rapidly across the nation; yet, little is known regarding such use in VHA. This gap is important because PICCs are associated with important complications including deep vein thrombosis and bloodstream infection. In addition, PICC insertion is a precious resource that requires skilled nursing teams, interventional radiologists and facilities capable of placing these devices. Despite this fact, accumulating evidence suggests PICC use is highly variable and may not always be appropriate. Moreover, patient perspectives regarding PICCs have been understudied. It is conceivable that they may be beneficial to some patients, but perhaps burdensome to others. This study will address each of these specific areas by focusing on physician, operator and patient views regarding PICCs. The overarching goal of this study is to better understand current use of PICCs in VHA, the extent to which such use is safe and effective and provide critical data to inform the development of interventions to enhance PICC safety across the VA healthcare system. The specific aims are to: Aim 1: Assess practice patterns, perceptions, preferences and reported outcomes related to PICCs through surveys of hospitalists, physician trainees, vascular nurses and interventional radiologists in VHA; Aim 2: Identify factors that influence PICC use, care and management via interviews of vascular access and bedside nurses, radiologists, hospitalists, physician trainees, and other key staff at purposefully selected sites; Aim 3: Explore patient perspectives regarding PICCs by interviewing Veterans who have received such devices so as to understand expectations, knowledge, benefits and burdens of PICC placement. The project will use a sequential explanatory mixed-methods design to develop a deep understanding of work system and other organizational factors associated with PICC use. Aim 1 will involve a survey of clinicians and operators to assess PICC related practices and perceptions across VA Medical Centers. Quantitative data from Aim 1 will inform the selection of sites for Aim 2 in which we will collect qualitative data through interviews and site visits to 6 VA Medical Centers. Aim 3 will provide additional insights through interviews with patients who have received PICCs at several of the sites we visit during Aim 2 of the project. The qualitative data collected in both Aims 2 and 3 and will be used to help understand the expected variation in our survey data. This study will be the first to examine clinician, operator and patient perspectives and preferences regarding PICCs in VHA. Given this focus, the relevance of this work to clinical practice, policy and patient safety is substantial and far-reaching. Once completed, this study will lay the groundwork for developing and deploying interventions that are tailored to the diverse work systems in which PICCs are placed within VHA to ensure safe and effective use of this device for Veterans across the VA system.
