Background, Rationale and Suggested Implementation Strategies
- Use the WISE Tool to understand drivers of short-term PICC use
- Assess staff knowledge and competency in placing peripheral IV catheters. Lack of skills in placing peripheral IV devices is a key driver of PICC use.
- Consider developing a method to identify patients who may have difficult intravenous access.
- Consider supervised peripheral IV insertion to ensure staff competency in placing these devices in appropriate sites with appropriate strategies
- Consider incorporating vein visualization technology (infra-red viewers) for patients with difficult or poor intravenous access. Visualization technology has been shown to improve success rates, decrease unsuccessful insertion attempts, improve satisfaction and avoid PICC placement
- Consider training staff in use of ultrasound technology to obtain access with short or long peripheral intravenous catheters in patients who have difficult venous access
- Consider developing a difficult IV Access team to manage patients who are either known to have difficulties with obtaining venous access or where attempts to place peripheral intravenous devices have failed after 2 or more attempts by experienced providers.
- Invest in alternatives to PICCs (especially if venous access <14 days is anticipated) including devices such as ultrasound guided peripheral intravenous catheters (USGPIV) and midlines.
- Understand and analyze peripheral IV failure rates and identify opportunities to reduce failure rates, maximize dwell times and reduce complications
- Consider creating specialized IV teams for difficult IV access to help gain access in patients with poor peripheral veins
- Assess rates of accidental catheter dislodgement. If accidental catheter dislodgement is identified as a potential reason for PICC use less than 5 days, the following strategies are recommended:
- Assess catheter securement practices
- Careful consideration for patients with confusion or acute delirium
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