This document summarizes the evidence-based incorporation of peripherally inserted central catheters (PICC) for cancer patients at Araba University Hospital. A literature review and training program was conducted before developing a protocol for PICC insertion, maintenance, and patient education. Over 200 PICCs were successfully inserted with few complications. PICCs provided a safe, effective long-term venous access alternative to implanted ports or central venous catheters at a lower cost. The process demonstrated how new technologies can be incorporated into clinical practice using an evidence-based approach.

1. Incorporating Peripherally Inserted
Central Catheters (PICC) into hospital
clinical practice
An example of evidence based process
Lucia Garate Echenique
Nursing Research Supervisor
lucia.garateechenique@osakidetza.net

2. Background
INCORPORATING TECHNOLOGY INTO HOSPITAL
CLINICAL PRACTICE
REQUEST TO
PURCHASING COMMITTEE
ACCEPTANCE REJECTION

3. Background
• Incorporating technology into hospital clinical practice
FEARS ECONOMICAL
ACHIEVEMENT OF
MANAGEMENT OBJETIVES RESURCES
PREVIOUS
CONCESSIONS
PROFESSIONAL
ATTITUD
PURCHASING PATIENT
COMMITTEE PREFERENCES
IMPRESSIONS OF PREVIOUS
CLINICAL BENEFIT PURCHASES/
INVESTMENTS

4. Background
PICC : Peripherally Inserted Central Catheter
 Long-term: Third generation polyurethane or silicone
 Inserted in upper arms: Peripherally inserted
 End of catheter in superior cava vein
 Can be inserted at bed-side by trained nurses

5. Background
LIFE CYCLE OF
HEALTH TECHNOLOGY
EMERGING
TECHNOLOGIES

6. Background
“Technologies have occasionally had rapid development and
dissemination in the health care system (…) influenced by factors
such as social pressure, commercial pressure, the enthusiasm of
health professionals, lack of barriers to their implementation or the
existence of technical difficulties for evaluation. This fact has led
sometimes to further demonstrate its ineffectiveness and even
harm.”
The EARLY ASSESSMENT OF EMERGING TECHNOLOGIES aims:
1. To identify characteristics in terms of improvement in clinical
practice, adverse effects, ethical and economic aspects.
2. To Help in the decision-making
3. To Prevent the undesirable consequences of the introduction
of new health technologies.

7. Objective
• To describe the evidence-based incorporation of
PICC for cancer patients in the Araba University
Hospital.

8. Methods
1) Bibliographic review: January 2010-June 2010
2) Nurses education/ training
3) Protocol desining: prior, insertion, postinsertion, education
for patients.
4) Database monitoring: success in placement, incidences,
duration, reasons for withdrawal, complications. June
2011.
5) Request to the Purchasing Commitee.
Acceptance: PICC (October 2010) & Ultrasound (Febreary
2011).
6) Observational prospective study

9. PATIENTS INTERVENTIONS COMPARISONS OUTCOME
Cancer PICC CVC DURATION
Patient PLACEMENT Implantable COMPLICATION
Ports SATISFACTION
Peripheral
Cathethers
UptoDATE
Tripdatabase MEDLINE
DARE MESH/ EMBASE
Cochrane EMTREE CINAHL
EMB Reviews
130 documents
retrieved

10. Methods
Depth: 0.5-1 cm
Depth: 0.5-1 cm
Diameter: 0,4 - -11
Diameter: 0,4
cm.
cm.
Microseldinger
Technique Ultrasound

11. PREINSERTION
INSERTION
POST INSERTION
MAINTENANCE
PATIENT
EDUCATION
Evidence Based
PROTOCOL DEVELOPMENT

12. Methods
Observational
Prospective Study

13. Methods
Request to the
Purchasing Committee

14. 10
15
20
25
0
5
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se 0
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oc
t-1
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ec
-1
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n-
11
95,8% to Cancer Patients
fe
b-
1
m 1
ar
-1
Ap 1
r-1
m 1
ay
-1
1
ju
n-
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ju
N=218 Inserted in Araba University Hospital
l-1
au 1
g-
1
se 1
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de 1
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Results

15. Results
100 100 100 100 100 100 100 100
95 94
90 91 90 92
84
80 80
75
70
66
60
56 54
% 50 50 50
40
30
20
INSERTION SUCCESS RATE 96.3% (CI 95%: 92.9 – 98.1)
10
0
10
11
10
1
11
Au 0
1
0
11
10
11
1
1
11
11
1
10
0
11
11
l-1
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-1
-1
t- 1
t-1
-1
r-1
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ar
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au
de
fe
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m
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D

16. Results
Withdrawed
N 90
Catheters
Mean 147.6
Median 99.5
Stand. Dev. 122,.2
Mín. 9,0
Max. 533.0
25 50,0
Percentiles 50 99.5
75 235.5

17. Results
TOTAL: 24,031 Catheter Days
Nº of Adverse Effects: 49
Adverse Effect TOTAL CATHETER DAYS = 24.031
95% CI: 1.5-2.7 /1,000 Catheter-Days
1
0,9
Complication/1,000
0,8
0,40
Catheter-Days
0,7 0,66
0,6
0,5 0,24
0,4
0,29 0,16
0,3 0,08 0,08
0,20 0,2
0,2
0,1 0,04
0
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=7 5) =5 =1
n =1 (n n= (n ( n
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18. IMPLANTED PORT PICC Results
247 € 95€
Operating Theatre Hospitalisation Room
90 min 60 min
CENTRAL VENOUS
1 Surgeon 1 Nurse DEVICES CONSUMPTION
1 Nurse 1 Auxiliary Nursign Care (2008-2012)
400 0,40
350
336
300 308
0,24 280
250
Implanted Port
200
214 0,16
Drum
0,08 0,08
150 CVC
112 PICC
100
29
50
0 0
18
08 09 10 11 12
20 20 20 20 20

19. Discussion
• PICC are an example of how technology can be incorporated
into hospital practice based on evidence criteria.
• However, the vast amount of technology hospitals manage and
the effort needed to search, read, and create evidence
constitute important difficulties to be faced in the technology
incorporation processes.
• In hospital routine this proccess may be insufficiently
protected. The creation of hospital based technology
evaluation committes could support the proccess of
incorporation technology following evidence-based criteria.

21. Implications for Practice
• PICC is now an available, safe, and cost-effective central
venous device in our hospital, preferable to other devices for
cancer patients.
• When the process of adquiring technology in hospitals involves
practicioners, researchers, material resources responsibles,
and managers it is easier to incorporate technology which is
relevant and appropriate, in both scientific and economical terms,
to clinical practice.

22. Thank you
Eskerrik Asko
Gracias
Lucia Garate Echenique
Nursing Research Supervisor
lucia.garateechenique@osakidetza.net