Comparisons of silicone and polyurethane Peripherally Inserted Central Catheter post insertion complications

Background; Peripherally inserted central catheters (PICC) are increasing in popularity in healthcare systems around the world. Positive patient satisfaction and clear fiscal savings combined with perceived low insertion and post insertion complication rates when compared to other options have secured the popularity of PICC in health care systems around the world. However little quality evidence is available to PICC inserters with regards to the safest catheter choice in order to produce the lowest levels of post insertion complications both in general adult populations as well as specific patient groups. Research question; Is the make of the PICC catheter (silicone or polyurethane) selected by nurse inserters a primary influence in patients experiencing post insertion complications? Data Analysis- Descriptive statistics were used to present demographic findings in both phases of the study. Phase One results were graphically portrayed, while Phase Two data was entered into the computer program SPSS (version 24). For Phase Two comparisons of post insertion complication rates and varying factors of both PICC type were analysed with Pearson chi test, categorical regression, two sample independent t-test, nonparametric binomial test and ANOVA. Methods; To address this research question a two phase study guided by the Gearing framework was undertaken in a Medical Imaging department of a large public hospital in Far North Queensland, Australia. The Gearing framework is a retrospective chart audit research design that comprises nine steps including: conception of the research, literature review, proposal development, data abstraction, development of protocols for data abstraction, chart audit tool, sample, ethical considerations and pilot. Phase One of the study comprised steps 1 and 2 in the Gearing framework. Consistent with the Gearing framework the literature review is presented as systematic review, and forms part of the data collection process. Phase Two encompassed steps 3 to 9 of the Gearing framework and the chart audit process. Using the tool developed in steps 1 to 9 a total of 379 charts were accessed and data recorded on 295 of these on a secure electronic device. Data collected included; demographic data, patient status, reason for insertion and reason for removal of PICC. Results; Phase One, the systematic literature review, found a large variance in reported post insertion complications from 8 to 50% of all PICC inserted. Both silicone and polyurethane PICC showed similar overall rates of post insertion complication however with closer examination strengths and weaknesses in each PICC type were noted. These finding were used to inform Phase Two of the study. Of the 295 PICC insertions included in Phase Two, 141 were silicone PICC and 154 polyurethane PICC. Various patient groups were contained within the sample including: inpatient (142), outpatient (80) and transitional (73). Reason for requiring a PICC identified 102 oncology patients, 164 requiring intravenous antibiotics and 29 requiring other types medications. Reasons for removal of catheter varied from no complication/ completion of therapy (67.8%), infection (11.2%), migration (5.8%), deceased (4.7%), occlusion (3.7%), thrombus (2.7%), breakage (2.7%), phlebitis (0.3%) and upgrade to triple lumen catheter (0.3%). Overall the number of lumens the PICC contained (p=.001) was shown to be a predictor of removal due to post insertion complications. Categorical regression showed that oncology, not the catheter type, (Beta 0.253, p=.083), to be the strongest predictor of complications. Conclusions; PICC remain a safe and reliable form of medium to long-term intravenous access across PICC types, patient groups and for all patient types. The greatest predictors of post insertion complications were number of lumens and oncology patient groups. The emerging trend of health facilities to transition inpatients to outpatients in the community with PICC insitu was shown to be a safe practice with similar post insertion complication levels to inpatients.