ABSTRACT
OBJECTIVES: To describe patterns of use, care practices, and outcomes related to peripherally inserted central catheter (PICC) use in skilled nursing facilities (SNFs). DESIGN: Prospective cohort study. SETTING: Two community SNFs. PARTICIPANTS: Adult SNF residents with PICCs (N = 56). MEASUREMENTS: Information on indication for PICC use, device characteristics (e.g., lumens, gauge), and participant data (comorbidities, medications) were obtained from medical records. Care practices (e.g., frequency of flushing, dressing care) and problems related to PICCs were recorded. Major (central line-associated bloodstream infection, venous thromboembolism, catheter dislodgement) and minor (migration, dressing disruption, lumen occlusion, exit site infection) complications and process measures (flushing of PICC, assessment of necessity) were recorded. Bivariate analyses with t-tests, chi-square tests, or Fischer exact tests were used for continuous and categorical data. RESULTS: Participants were enrolled from two SNFs. The most common indication for PICC use was intravenous antibiotic delivery. The average PICC dwell time was 43 days, and most devices were single-lumen PICCs. Major and minor complications were common and occurred in 11 (20%) and 18 (32%) participants, respectively. Occlusion (23%, n = 13), accidental dislodgement (12%, n = 7), and dressing disruption (11%, n = 6) were the commonest complications observed. Documentation regarding catheter care practices occurred in 41% of cases. CONCLUSION: Quality improvement efforts that seek to benchmark practice, identify gaps, and institute efforts to improve PICC care and practice in SNFs appear necessary.
Subject(s)
Catheterization, Central Venous/methods , Catheterization, Central Venous/statistics & numerical data , Aged , Catheterization, Peripheral , Female , Humans , Male , Pilot Projects , Prospective Studies , Skilled Nursing FacilitiesABSTRACT
Ensuring the safe transition of patients from hospitals to skilled nursing facilities and from skilled nursing facilities back to the hospital or the community can present significant challenges. The University of Michigan Health System was able to overcome many of these challenges through the implementation of a health system associated Subacute Care Service that consists of the University of Michigan Health System geriatricians and nurse practitioners working in privately operated skilled nursing facilities in our primary market area. We describe the planning process surrounding the development of the Subacute Care Service and report on efforts to date.
