The relationship between perceived role and appropriate use of peripherally inserted central catheters: A survey of vascular access nurses in the United States.

BACKGROUND

The presence and proliferation of vascular access nursing in hospital settings has been identified as a potential contributor to growing demand, and possible overuse, of peripherally inserted central catheters (PICCs).

OBJECTIVE

We examined vascular access nurses' perceived role related to use of PICCs and the association with appropriateness of PICC use in hospitals.

DESIGN

A web-based survey was administered to members of two vascular access professional organizations.

PARTICIPANTS

Of 2762 potentially eligible respondents who accessed the link, 1698 (61%) completed the survey. This sample was further restricted to vascular access nurses who worked in a U.S. hospital (n=1147).

METHODS

Respondents were categorized based on perceived role: 1) an operator who inserts PICCs; 2) a consultant whose views are not valued by the care team (unvalued consultant); 3) a consultant whose views are valued by the care team (valued consultant). Facility and respondent characteristics, reported practices, leadership support and relationships with other providers were compared across groups using chi-squared tests and analysis of variance. Multivariable logistic regression was used to assess the association between perceived role and reported percentage of PICCs placed for inappropriate reasons.

RESULTS

Among the 1147 respondents, 210 (18%) viewed themselves as operators, 683 (59%) as valued consultants, 236 (21%) as unvalued consultants, and 18 (2%) could not be categorized. A significantly higher percentage (93%) of valued consultants reported that vascular access nurses placed the majority of PICCs at their facility, compared to operators (83%) or unvalued consultants (76%) (p<0.001). After adjustment, compared with operators, valued consultants were significantly more likely to report that <10% of PICCs at their facility were inserted for inappropriate reasons (OR 1.7, p=0.002); the finding was reversed for unvalued consultants (OR 0.69, p=0.06).

CONCLUSIONS

Vascular access nurses and their perceived role as part of the healthcare team are associated with PICC use in hospitals. Strong inter-professional collaboration and respect may help ensure more appropriate use of PICCs.