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Updated: Feb 5, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Management of peripherally inserted central catheter use in an intensive care unit of a teaching hospital in Brazil:
Larissa Bertacchini de Oliveira1,2,3, Yago Russo Fava1, Adriano Rogério Baldacin Rodrigues1
1Heart Institute (InCor) of the Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Insights
Evidence-based practice for peripherally inserted central venous catheters (PICCs) in the ICU improved significantly after an educational program. Flushing compliance increased from 2-20% to 83-89%, enhancing patient safety.
Area of Science:
- Critical Care Medicine
- Nursing Practice
- Evidence-Based Healthcare
Background:
- Peripherally inserted central venous catheters (PICCs) are crucial for vascular access in intensive care units (ICUs).
- Limited use of PICCs in ICUs is often due to training and education gaps.
- These gaps hinder the improvement of PICC management practices and patient safety.
Purpose of the Study:
- To promote evidence-based practice in the management of PICCs for pediatric and adult patients in an ICU setting.
- To address identified barriers in PICC use and management within the ICU.
- To enhance the safety and efficacy of PICC utilization through improved practices.
Main Methods:
- A quasi-experimental study was conducted in a cardiology teaching hospital's ICU in São Paulo, Brazil.
- The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were utilized.
- Baseline and follow-up audits assessed PICC management in 22 and 14 patients, respectively, alongside 180 nursing staff, after an educational intervention.
Main Results:
- Baseline audit revealed poor compliance (2-20%) in PICC flushing.
- Compliance for changing administration sets ranged from moderate (65%) to high (100%).
- Post-intervention, all 10 audit criteria showed improvement, with flushing compliance reaching 83-89% and dressing/administration set changes achieving 100%.
Conclusions:
- The educational program successfully increased compliance with evidence-based best practices for PICC management.
- Highest compliance improvements were observed in criteria related to bloodstream infection prevention and preventing PICC obstruction.
- Future audits are planned to ensure the sustainability of improved PICC management practices.
Objective:
This project aimed to promote evidence-based practice in the management of peripherally inserted central venous catheters (PICCs) in pediatric and adult patients in an intensive care unit (ICU).
Introduction:
A PICC provides secure vascular access to medication, blood and nutrition administration. However, their use in the ICU is limited. Gaps in training and education in the use of these catheters are barriers to improving practice and safety.
Methods:
The project was conducted in an ICU of a cardiology teaching hospital in São Paulo, Brazil. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used. A baseline audit of the management of PICCs in pediatric and adult patients was conducted, with a sample size of 22 patients and 180 nursing staff. After an educational program, a follow-up audit involving 14 patients and 180 nursing staff was conducted using the same audit criteria.
Results:
The baseline audit indicated that PICC management concerning flushing had poor compliance of 2-20%. The results of the criteria related to the change in administration sets, including secondary sets and add-on devices, had better results, with moderate (65%) to high (100%) compliance. The follow-up audit showed improvement in all 10 criteria. Criteria related to flushing achieved 83% to 89% compliance; criteria related to dressing and change of administration sets achieved 100% compliance.
Conclusions:
Increased compliance with evidence-based best practices was achieved in all assessed audit criteria. The criteria that reached the highest compliance with best practice recommendations were related to the prevention of bloodstream infection and loss of the PICC due to obstruction. Future audits are planned to ensure sustainability.
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