Development and Implementation of a Bedside Peripherally Inserted Central Catheter Service in a PICU.

Area of Science:

• Pediatric critical care medicine
• Vascular access procedures
• Quality improvement initiatives

Background:

• Peripherally inserted central catheters (PICCs) are crucial for pediatric intensive care unit (PICU) patients.
• Timely and safe PICC placement is essential for effective patient management.
• Existing placement methods may lead to delays and suboptimal outcomes.

Purpose of the Study:

• To establish a dedicated bedside peripherally inserted central catheter (PICC) service within a quaternary noncardiac PICU.
• To enhance the efficiency and patient-centeredness of PICC placements.
• To evaluate the impact of the bedside service on placement times and safety metrics.

Main Methods:

• A two-phase observational, pre-post design was implemented over two years.
• A multidisciplinary team developed an evaluation tool to identify suitable patients and guide procedure performance.
• Outcome, process, and balancing metrics were systematically collected and analyzed.

Main Results:

• The bedside PICC service successfully placed 130 PICCs, contributing to 2,447 central catheter days.
• Median placement time was significantly reduced from 34 hours (Interventional Radiology) to 6 hours (bedside service) (p < 0.001).
• Successful access was achieved in 96% of cases, with 97% achieving central tip position. Safety metrics (CLABSI, VTE) were comparable to traditional methods and lower than PICU temporary catheters.

Conclusions:

• Implementation of a bedside PICC service effectively increased PICC utilization in PICU patients.
• The service provided a patient-centered and timely approach to vascular access.
• Key safety indicators, including central line-associated bloodstream infections and venous thromboembolism, remained comparable to those from interventional radiology placements.