There is not any such national average. And I have no idea how that would even be established. It would require a huge database with lots of facilities feeding data into it. That does not exist. You can find many published articles with rates of complications. But the problem is there are no standard definitions for how those are reported. Exactly what do you mean by "occlusion" - intraluminal or intravenous?? Lynn
Thanks for your reply. I am referring to intraluminal. We are tracking these occlusion rates as we have noticed an increase since the Solo2 has been implemented. We are looking at all factors, including the indivdual inserter as technique, no doubt, influences PICC intraluminal occlusion occurance (at least that is my understanding). We are thinking a benchmark would be nice to compare our rates.
Comparing your rates with one valved product to others rates in a nonvalved catheter or another type of valve would not provide any useful information. All valves built into catheters have very different designs, locations, and outcomes. I know there has been lots of discussion about the outcomes with the Solo catheters on this forum so you might want to do a search for that information. I know the manufacturer made some changes to this valve but your outcomes seem to be the same as what others were seeing with the first version. Lynn
I think that occlusions can happen for many reasons. Our patients care sometimes very ill and may be more prone to occlusion. Are the nurses properly flushing after blood draws. We flush our PICC's on as a routine SCHEDULE med on the EMR to ensure they are being flushed. I know this is above what is recommended. However, since we have instituted routine q8 hour flushing our rate of occulded lines dropped significantly. And I do use the Power PICC Solo. I track the use of cathflo and out of the 80 PICC placed per month we average using cath flo 4-6 times per week. However it is sometimes repeat doses on the same patient several days apart.
I have been keeping stats of all my picc insertion for the past 2 years (166 piccs - 5558 catheter-days) as a quality improvement initiative. I work in a rather small institution so I am able to keep track of all lines. Occlusions (partial - defined by the absence of blood return but not resistance when flushing (after rulling out mechanical occlusion) and complete occlusion - defined by the absence of blood return and the impossibility to flush) are part of the complications that I follow. We insert both valved catheters (Bard Groshong, 3,4,5 FR) and open ended catheters (Cook DL 5Fr). Valved catheters are routinely flushed with saline, 10cc, before and after use or once a week when not in use and open ended catheters are flushed with NS, 10 cc followed by heparine 10 units (recently increased to 30 units) (10units/ml) after usage, q 8 hours.
Partial occlusion rate for the open ended catheters is 26.32% (10 catheters/38 occluded at least 1 time - average # occlusion: 1.6)
Partial occlusion rate for the valved catheters is 4.69% (6 catheters/128 occluded at least 1 time - average # occlusion: 1.17)
Complete occlusion rate for the open ended catheters is 7.69% (3 catheters/38 occluded at least 1 time - average # occlusion: 1)
Partial occlusion rate for the valved catheters is 3.13% (4 catheters/128 occluded at least 1 time - average # occlusion: 1)
I work with a population who has chronic lung disease and most of my lines are use for antibiotics administration.
It is far from National data, I have to admit...
I have recently published an article in Perspective Infirmière (April-May 2010, p. 29-34) in French, on the insertions of the Groshong catheters only.
France Paquet, RN, MSc
Clinical Nurse Specialist, Respirology
MUHC, Montreal, Quebec, CANADA
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
You will only find a national average or mean/median number for CRBSI from the NHSN system. These numbers do not break down by types of catheters such as PICCs vs other CVCs. This is the one and only national database for any type of catheter complication. So you will not find any national benchmarking number for any catheter related complication other than infection. I do know that the next edition of the CDC guidelines will focus on Zero as the goal. So we should never be satisfied with looking at what others are doing, comparing our outcomes and saying that is good enough. We must constantly be working toward Zero. That is the message that come through loud and clear at the recent CDC conference I attended last week. Lynn
There is not any such national average. And I have no idea how that would even be established. It would require a huge database with lots of facilities feeding data into it. That does not exist. You can find many published articles with rates of complications. But the problem is there are no standard definitions for how those are reported. Exactly what do you mean by "occlusion" - intraluminal or intravenous?? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
Thanks for your reply. I am referring to intraluminal. We are tracking these occlusion rates as we have noticed an increase since the Solo2 has been implemented. We are looking at all factors, including the indivdual inserter as technique, no doubt, influences PICC intraluminal occlusion occurance (at least that is my understanding). We are thinking a benchmark would be nice to compare our rates.
Tami Mendonca
Comparing your rates with one valved product to others rates in a nonvalved catheter or another type of valve would not provide any useful information. All valves built into catheters have very different designs, locations, and outcomes. I know there has been lots of discussion about the outcomes with the Solo catheters on this forum so you might want to do a search for that information. I know the manufacturer made some changes to this valve but your outcomes seem to be the same as what others were seeing with the first version. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I think that occlusions can happen for many reasons. Our patients care sometimes very ill and may be more prone to occlusion. Are the nurses properly flushing after blood draws. We flush our PICC's on as a routine SCHEDULE med on the EMR to ensure they are being flushed. I know this is above what is recommended. However, since we have instituted routine q8 hour flushing our rate of occulded lines dropped significantly. And I do use the Power PICC Solo. I track the use of cathflo and out of the 80 PICC placed per month we average using cath flo 4-6 times per week. However it is sometimes repeat doses on the same patient several days apart.
Hope that helps.
Rhonda Wojtas, RN,BSN, VA-BC
Hello,
I have been keeping stats of all my picc insertion for the past 2 years (166 piccs - 5558 catheter-days) as a quality improvement initiative. I work in a rather small institution so I am able to keep track of all lines. Occlusions (partial - defined by the absence of blood return but not resistance when flushing (after rulling out mechanical occlusion) and complete occlusion - defined by the absence of blood return and the impossibility to flush) are part of the complications that I follow. We insert both valved catheters (Bard Groshong, 3,4,5 FR) and open ended catheters (Cook DL 5Fr). Valved catheters are routinely flushed with saline, 10cc, before and after use or once a week when not in use and open ended catheters are flushed with NS, 10 cc followed by heparine 10 units (recently increased to 30 units) (10units/ml) after usage, q 8 hours.
Partial occlusion rate for the open ended catheters is 26.32% (10 catheters/38 occluded at least 1 time - average # occlusion: 1.6)
Partial occlusion rate for the valved catheters is 4.69% (6 catheters/128 occluded at least 1 time - average # occlusion: 1.17)
Complete occlusion rate for the open ended catheters is 7.69% (3 catheters/38 occluded at least 1 time - average # occlusion: 1)
Partial occlusion rate for the valved catheters is 3.13% (4 catheters/128 occluded at least 1 time - average # occlusion: 1)
I work with a population who has chronic lung disease and most of my lines are use for antibiotics administration.
It is far from National data, I have to admit...
I have recently published an article in Perspective Infirmière (April-May 2010, p. 29-34) in French, on the insertions of the Groshong catheters only.
France Paquet, RN, MSc
Clinical Nurse Specialist, Respirology
MUHC, Montreal, Quebec, CANADA
France Paquet, RN, MSC, VA-BC(TM), CVAA(c)
Clinical Practice Consultant, IV therapy and Vascular Access
Transition support office
McGill University Health Center
Montreal, Quebec, CANADA
You will only find a national average or mean/median number for CRBSI from the NHSN system. These numbers do not break down by types of catheters such as PICCs vs other CVCs. This is the one and only national database for any type of catheter complication. So you will not find any national benchmarking number for any catheter related complication other than infection. I do know that the next edition of the CDC guidelines will focus on Zero as the goal. So we should never be satisfied with looking at what others are doing, comparing our outcomes and saying that is good enough. We must constantly be working toward Zero. That is the message that come through loud and clear at the recent CDC conference I attended last week. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861