We are a small nurse led team who place peripherally inserted central catheters (PICCs) on a chemotherapy day unit in a small district general hospital. We place approximately 100 PICCs per year solely for our patient group. The aim of this project was to improve the PICC insertion procedure by utilising the Sherlock 3CG Tip confirmation system for placements of PICCs. This would minimise the delay between insertion and use of the catheter, avoid the need for a chest x-ray to confirm the PICC tip position and increase staff confidence during insertions.
Aims and objectives
We were attempting to improve the PICC insertion procedure: The case for adopting the Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters is supported by the evidence
Improve patient experience and reduce the requirement of a post insertion chest x-ray to confirm tip position.
Using the technology increases staff confidence during catheter insertion as it uses magnetic real time tracking of the PICC which reduces the misplacement of PICC's
Reduce cost and reduce the requirement of a post insertion chest x-ray to confirm tip position.
Reasons for implementing your project
The population of North Somerset is 202,566 with one in five patients being over 65 years of age. Weston General Hospital has 245 in-patient beds. The Oncology and Haematology department is an out-patient day unit that sees approx. 25-30 patients per day for anti-systemic cancer therapy. The PICC clinic is held on Wednesdays and on average we insert 2-3 PICCs per week.
Prior to this project PICCs were placed using ultrasound to access the veins with tip confirmation confirmed by chest x-ray.
We had a simple database that looked at dates, numbers, infection and thrombus rates. With no firm data on misplacements but looking back through x-ray results we had a fair few misplacements with the PICC entering the jugular vein rather than the superior vena cava. On average, the time for patients to attend x-ray and return to the department was 1 hour.
We regularly attend the South West PICC placers precepting programme-clinical supervision day and became aware of the 3CG technology being used at other hospitals.
This alerted us to the fact that we could improve the patient experience, improve our practice and introduce cost savings
How did you implement the project
Initially discussions were held with the lead venous access nurse at Bristol Haematology and Oncology Centre, we attended the centre to see the Sherlock in use and were given advice on how to write the business case. We then wrote and submitted a business case to the charitable funds board who agreed that this novel technology should be purchased but frustratingly they felt it should be funded from the hospital capital budget. The business case was re-submitted and accepted.
The project has met the initial aims and objectives.
The average time for the patient to have a PICC placed with tip conformation is 60-90 minutes compared to PICC placement and chest x-ray 90 minutes to 150 minutes saving approx. 60 minutes per patient
Previous cost single PICC £149.82 plus chest x-ray £75 = £225
Based on 91 PICC placements per annum = £20.475
Single Sherlock cost £177
Based on 91 placements per annum= £16,107
In 2016 based on 91 PICC placements that year the trust saved £4,368
The patient experience has improved as they have avoided misplaced PICC insertions and avoided delays in treatment due to not having to attend the x-ray department
Key learning points
Key learning points would be to:
Seek advice on writing the business case
Keep a robust audit trail of PICC complications and timings as this can support your application for change
If successful expect a steep learning curve when learning new equipment and a new technique as it is very difficult to go from being an expert to a novice!