The patient experience of a peripherally inserted central catheter (PICC): A qualitative descriptive study

"They go hand in hand": a patient-oriented, qualitative descriptive study on the interconnectedness between chronic health and mental health conditions in transition-age youth

BACKGROUND

Transition-age youth (TAY) with chronic health conditions frequently experience co-occurring mental health conditions. However, little is known about the perspectives of TAY with co-occurring diagnoses preparing to exit pediatric health and mental health services. Research is needed to understand the impact of a mental health condition on transition readiness and self-management in TAY with chronic health conditions.

METHODS

TAY (aged 16-20 years) with co-occurring chronic health and mental health conditions were recruited in Alberta, Canada. Nine semi-structured individual interviews were completed by phone or videoconference, and transcribed verbatim. Guided by qualitative description, we analyzed the data using thematic analysis in partnership with five young adults with lived experience in the health/mental health systems.

RESULTS

Participants shared their experiences living with simultaneous physical and mental health concerns and preparing for transition to adult care. Our analysis revealed three overarching themes: 1) "they're intertwined": connections between chronic health and mental health conditions in TAY, 2) impact of mental health on transition readiness and self-management, and 3) recommendations for service provision from the perspectives of TAY.

CONCLUSIONS

Our findings highlighted the myriad ways in which physical and mental health are connected as TAY prepare for service transitions using specific examples and powerful metaphors. TAY endorsed the importance of providers discussing these connections in routine clinical care. Future research should involve co-designing and evaluating educational material addressing this topic with diverse TAY, caregivers, and service providers.

Kinesiophobia and related factors in cancer patients with TIAPs during the long term: a cross-sectional survey

OBJECTIVE

This study is designed to investigate the status of kinesiophobia and related factors in cancer patients with totally implantable venous access ports (TIAPs).

METHODS

This is a cross-sectional study; all the participants were recruited from the Oncology Department and the Daytime Chemotherapy Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, from April 1 to May 31, 2021. The participants were interviewed by researchers using the self-made general information questionnaire and the Tampa Scale of Kinesiophobia-11 (TSK-11) scale, which allows the fear of movement to be quantified. Eligible patients were aged ≥ 18 years, confirmed with cancer, and implanted with a port. The logistic regression model was used to evaluate clinical factors and the risk of kinesiophobia.

RESULTS

A total of 282 patients were recruited (aged 58.0 ± 11.5 years), of which gastrointestinal cancer accounted for 54.6%, breast cancer accounted for 22.7%, lung cancer accounted for 11.3%, and other types accounted for 11.3%. The TSK-11 score of the 282 patients was 17.84 ± 6.06 points, 45.7% of the patients reported mild kinesiophobia (TSK-11 ≥ 18), 18.4% of the patients reported moderate to severe kinesiophobia (TSK-11 ≥ 25), and the highest score reached 34 points. Results of logistic regression analysis showed that exercise habits (P = 0.025), pain (P = 0.023), and foreign body sensation (P = 0.003) were the risk factors of kinesiophobia.

CONCLUSION

Kinesiophobia is common in cancer patients with TIAPs, and it is closely related to the subjective experience of daily activities, which requires more attention and early intervention to reduce the potential adverse effects.

Adult oncology patients' experiences of living with a central venous catheter: a systematic review and meta-synthesis

BACKGROUND

The incidence of cancer is increasing globally, and a greater number of patients will receive treatments though central vascular access devices (CVADs). Only a few qualitative studies describe the experience of adult oncology patients living with CVADs, and no systematic review of literature has been published on this topic. We therefore aimed to systematically synthesize the evidence of the qualitative studies on the experience of adult oncology patients with CVADs to report the implications of living with this device, and to inform healthcare professionals (HCPs) about problematic aspects of care for this population.

METHODS

A comprehensive literature review was conducted on PUBMED, MEDLINE, SCOPUS, COCHRANE, and WEB OF SCIENCE, and was updated on May 25, 2021. Nine studies fulfilled the inclusion criteria. The evidence was synthesized using the meta-aggregation approach proposed by the Joanna Briggs Institute.

RESULTS

Four themes emerged: During catheter implantation oncology patients typically experience reluctance, apprehension and acceptance; The nature of the information, knowledge transmission and HCPs' competence all influence the patient's confidence; How the presence of a catheter impacts the patient's daily life, their self-perception and their social behavior; The catheter is a symbol of disease, a friend that helps prevent problems, and its removal is perceived as physical and psychological liberation.

CONCLUSION

This systematic review evidenced some problematic aspects related to patient information, education and device management, and gaps in nursing skills on handling the device. The results of this review should be used as a framework for improvement interventions.

Venous access devices for the delivery of long-term chemotherapy: the CAVA three-arm RCT

BACKGROUND

Venous access devices are used for patients receiving long-term chemotherapy. These include centrally inserted tunnelled catheters or Hickman-type devices (Hickman), peripherally inserted central catheters (PICCs) and centrally inserted totally implantable venous access devices (PORTs).

OBJECTIVES

To evaluate the clinical effectiveness, safety, cost-effectiveness and acceptability of these devices for the central delivery of chemotherapy.

DESIGN

An open, multicentre, randomised controlled trial to inform three comparisons: (1) peripherally inserted central catheters versus Hickman, (2) PORTs versus Hickman and (3) PORTs versus peripherally inserted central catheters. Pre-trial and post-trial qualitative research and economic evaluation were also conducted.

SETTING

This took place in 18 UK oncology centres.

PARTICIPANTS

Adult patients (aged ≥ 18 years) receiving chemotherapy (≥ 12 weeks) for either a solid or a haematological malignancy were randomised via minimisation.

INTERVENTIONS

Hickman, peripherally inserted central catheters and PORTs.

PRIMARY OUTCOME

A composite of infection (laboratory confirmed, suspected catheter related and exit site infection), mechanical failure, venous thrombosis, pulmonary embolism, inability to aspirate blood and other complications in the intention-to-treat population.

RESULTS

Overall, 1061 participants were recruited to inform three comparisons. First, for the comparison of peripherally inserted central catheters (n = 212) with Hickman (n = 212), it could not be concluded that peripherally inserted central catheters were significantly non-inferior to Hickman in terms of complication rate (odds ratio 1.15, 95% confidence interval 0.78 to 1.71). The use of peripherally inserted central catheters compared with Hickman was associated with a substantially lower cost (-£1553) and a small decrement in quality-adjusted life-years gained (-0.009). Second, for the comparison of PORTs (n = 253) with Hickman (n = 303), PORTs were found to be statistically significantly superior to Hickman in terms of complication rate (odds ratio 0.54, 95% confidence interval 0.37 to 0.77). PORTs were found to dominate Hickman with lower costs (-£45) and greater quality-adjusted life-years gained (0.004). This was alongside a lower complications rate (difference of 14%); the incremental cost per complication averted was £1.36. Third, for the comparison of PORTs (n = 147) with peripherally inserted central catheters (n = 199), PORTs were found to be statistically significantly superior to peripherally inserted central catheters in terms of complication rate (odds ratio 0.52, 95% confidence interval 0.33 to 0.83). PORTs were associated with an incremental cost of £2706 when compared with peripherally inserted central catheters and a decrement in quality-adjusted life-years gained (-0.018) PORTs are dominated by peripherally inserted central catheters: alongside a lower complications rate (difference of 15%), the incremental cost per complication averted was £104. The qualitative work showed that attitudes towards all three devices were positive, with patients viewing their central venous access device as part of their treatment and recovery. PORTs were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. The main limitation was the lack of adequate power (54%) in the non-inferiority comparison between peripherally inserted central catheters and Hickman.

CONCLUSIONS

In the delivery of long-term chemotherapy, peripherally inserted central catheters should be considered a cost-effective option when compared with Hickman. There were significant clinical benefits when comparing PORTs with Hickman and with peripherally inserted central catheters. The health economic benefits were less clear from the perspective of incremental cost per quality-adjusted life-years gained. However, dependent on the willingness to pay, PORTs may be considered to be cost-effective from the perspective of complications averted.

FUTURE WORK

The deliverability of a PORTs service merits further study to understand the barriers to and methods of improving the service.

TRIAL REGISTRATION

This trial is registered as ISRCTN44504648.

FUNDING

This project was funded by the National Institute for Health Research (NHIR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 47. See the NIHR Journals Library website for further project information.

Potential Benefits of Multimedia-Based Home Catheter Management Education in Patients With Peripherally Inserted Central Catheters: Systematic Review

Background

In recent years, there have been many suggestions to use multimedia as a strategy to fully meet the educational needs of patients with peripherally inserted central catheters. However, the potential benefits remain unreliable in the literature.

Objective

In this study, we identified the potential benefits of multimedia-based home catheter management education in patients with peripherally inserted central catheters and discussed the clinical implications.

Methods

We performed systematic searches of the PubMed, Cochrane Library, Embase Ovid, Medline, BioMed Central-cancer (BMC-cancer), ScienceDirect, and Google Scholar databases without date constraints until November 30, 2019. The methodological quality of the eligible studies was appraised using the Cochrane risk of bias tool. Narrative synthesis of the study findings was conducted.

Results

A total of 6 intervention studies met the inclusion criteria, including 3 randomized controlled trials and 3 case-control studies/quasi-experimental studies. The studies included a total of 355 subjects, including a total of 175 in the multimedia groups and 180 in the control groups. We identified 4 potential benefits to patients: (1) improved knowledge, (2) increased satisfaction, (3) reduced incidence of catheter-related complications, and (4) reduced number of cases of delayed care after complications.

Conclusions

The current systematic review highlights the potential benefits of multimedia-based home catheter management education for patients with peripherally inserted central catheters.

Patient experiences with peripherally inserted venous catheters- A cross-sectional, multicentre study in Norway

Aim

To investigate patient experiences with peripherally inserted venous catheters, namely PICC lines and Midlines, as well as the influence of socio-demographic variables, length of stay, comorbidity and complications on these experiences.

Design

The study had a descriptive, multicentre, cross-sectional design.

Methods

We used a questionnaire to investigate patient experiences (N = 359).

Results

Patients experiences were not optimal on each of the items in the questionnaire. Nevertheless, few respondents would have preferred a traditional peripheral venous catheter instead. Moreover, free-text answers indicated that patients were very satisfied with their catheter. Results also indicate that the hospitals have different approach when selecting a PICC line or a Midline as route of choice. The only factor associated with patient experiences was "complications."

Conclusion

Even though patients reported of several disadvantages with the PICC line/Midline, findings indicate that they would have chosen this again. PICC lines and Midlines are beneficial from the patients' perspective, even though they have disadvantages.

What do patients say about their experience with urinary catheters and peripherally inserted central catheters?

BACKGROUND

Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices.

METHODS

As part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral.

RESULTS

Positive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other.

CONCLUSIONS

Our findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs.

Patient acceptability of three different central venous access devices for the delivery of systemic anticancer therapy: a qualitative study

OBJECTIVE

Three types of central venous access devices (CVADs) are routinely used in the delivery of intravenous systemic anticancer therapy (SACT): peripherally inserted central catheters (PICCs), subcutaneously tunnelled central catheters (Hickman-type devices) and totally implantable chest wall ports (Ports). This qualitative study, nested within a multicentre, randomised controlled trial, sought to explore patient acceptability and experiences of the three devices.

DESIGN

Eight focus groups were audio-recorded, transcribed and thematically analysed.

SETTING

Six outpatient cancer treatment centres in the UK.

PARTICIPANTS

Forty-two patients (20 female, mean age 61.7 years) who had taken part or were taking part in the broader trial.

INTERVENTION

As part of the larger, randomised controlled trial, participants had been randomly assigned one of three CVADs for the administration of SACT.

RESULTS

Attitudes towards all three devices were positive, with patients viewing their CVAD as part of their treatment and recovery. Participants with PICCs and Hickmans tended to compare their device favourably with peripheral cannulation. By comparison, participants with Ports consistently compared their device with PICCs and Hickmans, emphasising the perceived superiority of Ports. Ports were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships.

CONCLUSIONS

Patient experiences and preferences have not been systematically used to inform policy and practice regarding CVAD availability and selection. Our research identified patterns of patient device preferences that favoured Ports, although this was not universal. Results of this study could improve support for patients and offer greater scope for incorporating patient perspectives into decision-making processes.

TRIAL REGISTRATION NUMBER

ISRCTN44504648.

Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study

Objective

Peripherally inserted central catheters (PICC) are frequently used to deliver medical therapies, but our knowledge regarding PICC-related complications remains incomplete. The objective of this study was to systematically elicit and characterise PICC-related complications as experienced by patients during and after hospitalisation.

Design

Prospective cohort study.

Setting

Inpatient medical units at four US hospitals in two states.

Participants

Consecutive sample of patients who had a new PICC placed during a hospital stay between August 2015 and May 2017.

Main outcome(s)

Patient-reported signs and symptoms of a possible PICC-related complication or functional issues.

Results

Of the 438 patients in the analytic cohort (91.4% of those consented), two-thirds were male with a mean age of 56 years. The most common reason for PICC placement was long-term antibiotic therapy (43.4%). During the 70-day follow-up period, 61.4% of patients reported signs of at least one complication, including potentially serious complications, such as bloodstream infection (17.6%) and deep vein thrombosis (30.6%). Correspondence of these reported events with medical record documentation of the complication was generally low. More than one-quarter (27.9%) of patients reported minor complications, such as insertion site redness, discomfort or difficult removal. While the PICC was in place, 26.0% reported restrictions in activities of daily living, 14.4% social activity restrictions and 19.2% had difficulty with flushing or operating the PICC.

Conclusion

Over 60% of patients report signs or symptoms of a possible complication or adverse effect after PICC placement. Bothersome complications from the patient perspective are clearly more common than those that typically rise to the level of healthcare provider attention or concern. Understanding the patient experience is critical for providing safe and effective care.

Hot Compress with Chinese Herbal Salt Packets Reducing PICC Catheter Complications: A Randomized Controlled Trial

OBJECTIVE

To explore the preventive effect of applying hot compress with Chinese herbal salt packets (CHSP) to puncture vessels under aseptic conditions during peripherally inserted central catheter (PICC) on postoperative phlebitis.

METHODS

A total of 720 hospitalized patients undergoing first PICC were assigned to treatment and control groups (360 cases each group) according to a random number table. The control group received conventional catheterization and nursing care. The treatment group was first given hot compress with CHSP (which consisted of honeysuckle 30 g, Semen brassicae 30 g, Salvia miltiorrhiza 30 g, Angelica dahurica 30 g, Semen raphani 30 g, Evodia rutaecarpa 30 g, and coarse salt 20 g) on the punctured vessel under aseptic conditions for 5-10 min before conventional catheterization. The main efficacy indices were the vessel diameters before and during catheterization and the success rate of a single catheter, and the secondary efficacy indiex was the incidence of superficial phlebitis within 1 week after catheterization.

RESULTS

The vessel diameter during catheterization of the treatment group was remarkably increased compared with the control group [(7.96±0.42) mm vs. (4.39±0.54) mm, P<0.01]. The success rate of the single catheter of the treatment group was significantly higher than that of the control group [94.00% (329/350) vs. 73.72% (244/329), P<0.01]. The incidence of superficial phlebitis within 1 week after catheterization in the treatment group was lower than that in the control group (P=0.007). There was no adverse event with CHSP.

CONCLUSION

Hot compress with CHSP during PICC is applicable as it can effectively improve the success rate of a single catheter and reduce the incidence of superficial phlebitis after catheterization (Trial registration No. ChiCTR-ONC-17010498).

Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries

Peripheral intravascular cannula/catheter (PIVC) insertion is a common invasive procedure, but PIVC failure before the end of therapy is unacceptably high. As PIVC failure disrupts treatment and reinsertion can be distressing for the patient, prevention of PIVC failure is an important patient outcome. Consumer participation in PIVC care to prevent failure is an untapped resource. This study aimed to understand consumers’ PIVC experience; establish aspects of PIVC insertion and care relevant to them; and to compare experiences of adult consumers to adult carers of a child. An international, web-based, cross-sectional survey was distributed via social media inviting adult consumers and adult carers of a child under 18 years who had experienced having a PIVC in the last five years (one survey each for adults and adult carers) to complete a 10-item survey. As such, sampling bias is a limitation and results should be carefully considered in light of this. There were 712 respondents from 25 countries, mainly female (87.1%) and adults (80%). A little over 50% of adults described insertion as moderately painful or worse, with level of insertion difficulty (0–10 scale) identified as moderate (median 4, IQR 1, 7). Adult carers reported significantly more pain during insertion and insertion difficulty (both p < 0.001). Rates of first insertion attempt failure were higher in children compared with adults (89/139 [64%] vs 221/554 [40%]; p < 0.001), and 23% of children required ≥ 4 attempts, compared with 9% of adults (p < 0.0001). Three themes from open-ended question emerged: Significance of safe and consistent PIVC care; Importance of staff training and competence; and Value of communication. The PIVC experience can be painful, stressful and frustrating for consumers. Priorities for clinicians and policy makers should include use of pain relief as standard practice to reduce the pain associated with PIVC insertion and developing strategies to increase first PIVC insertion attempt success particularly for children and older consumers.

Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study

PURPOSE

The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment.

METHODS

A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines.

RESULTS

Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle.

CONCLUSIONS

Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients.

Characteristics of Qualitative Descriptive Studies: A Systematic Review

Qualitative description (QD) is a term that is widely used to describe qualitative studies of health care and nursing-related phenomena. However, limited discussions regarding QD are found in the existing literature. In this systematic review, we identified characteristics of methods and findings reported in research articles published in 2014 whose authors identified the work as QD. After searching and screening, data were extracted from the sample of 55 QD articles and examined to characterize research objectives, design justification, theoretical/philosophical frameworks, sampling and sample size, data collection and sources, data analysis, and presentation of findings. In this review, three primary findings were identified. First, although there were some inconsistencies, most articles included characteristics consistent with the limited available QD definitions and descriptions. Next, flexibility or variability of methods was common and effective for obtaining rich data and achieving understanding of a phenomenon. Finally, justification for how a QD approach was chosen and why it would be an appropriate fit for a particular study was limited in the sample and, therefore, in need of increased attention. Based on these findings, recommendations include encouragement to researchers to provide as many details as possible regarding the methods of their QD studies so that readers can determine whether the methods used were reasonable and effective in producing useful findings. © 2016 Wiley Periodicals, Inc.