Joint Department of Medical Imaging, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada.
Joint Department of Medical Imaging, Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada.
J Med Imaging Radiat Sci. 2020 Sep;51(3):373-378. doi: 10.1016/j.jmir.2020.05.003. Epub 2020 Aug 14.
Peripherally inserted central catheters, also known as PICC lines, are very common procedures for patients in the hospital who need to have long-term intravenous access, for various reasons such as antibiotics or total parenteral nutrition. At our institution, there is currently only one interventional radiology (IR) suite in our department to accommodate all IR procedures. Therefore, the bedside PICC program was introduced to help alleviate the workload in the IR suite and to improve overall patient care. Under the supervision of the hospital's interventional radiologists, trained x-ray technologists (medical radiation technologists [MRTs]) are inserting PICCs at the bedside. The purpose of this article is to describe the creation of a bedside PICC program by x-ray technologists in a hospital setting and to analyze the PICC insertions performed by MRTs over a six-year period.
In 2012, a bedside PICC insertion program was developed at our hospital, whereby two technologists would perform the procedure, using the Site-Rite® 8 Ultrasound System alongside the integrated Sherlock 3CG™ Diamond Tip Confirmation System. Training on these systems and procedural techniques, including venipuncture, sterile technique, and equipment knowledge and troubleshooting was provided for technologists. The point-of-care program was revamped in 2017 in that only one technologist would go to the bedside alone for PICC insertions. All data for the analyses were obtained from the Radiology Information System program used by our medical imaging department, called Coral RIS/PACS.
Owing to staffing issues and inconsistent scheduling, an overview of yearly volumes of bedside PICCs performed increased from 45 in 2012 to 486 in 2018. After program changes made in 2017, these changes yielded a total volume of 382 of bedside PICCs performed, and an even more remarkable amount of 486 in 2018. For these two latter years, an evaluation of the program was carried out by analyzing how many bedside PICCs were performed successfully by the solo technologist. Overall success was achieved for both years: in 2017, 82% of the cases were performed by the technologist alone without any assistance, and likewise 89% in 2018.
Since the onset of this process improvement initiative, the bedside PICC program by MRTs under the supervision of the interventional radiologists at our institution has benefited many patients and the hospital as a whole. It was apparent during the development of the program that consistent scheduling of trained and dedicated MRTs to do these bedside procedures on a regular basis improved the efficiency of the program.
外周静脉置入中心导管（PICC）也称为 PICC 置管，对于因各种原因需要长期静脉输液的住院患者来说是一种非常常见的操作，例如使用抗生素或全胃肠外营养。在我们的机构中，目前只有一个介入放射科（IR）套房来容纳所有的 IR 操作。因此，引入了床边 PICC 计划，以帮助减轻 IR 套房的工作量，并改善整体患者护理。在医院介入放射科医生的监督下，经过培训的 X 光技师（医学放射技师 [MRT]）在床边进行 PICC 置管。本文的目的是描述医院环境中由 X 光技师创建床边 PICC 计划，并分析 MRT 在六年期间进行的 PICC 置管操作。
2012 年，我们医院开发了床边 PICC 置管程序，两名技师使用 Site-Rite®8 超声系统和集成的 Sherlock 3CG™Diamond Tip Confirmation System 进行该操作。为技师提供了这些系统和程序技术的培训，包括静脉穿刺、无菌技术以及设备知识和故障排除。2017 年对床边程序进行了修改，即只有一名技师单独到床边进行 PICC 置管。所有分析数据均来自我们医学影像部门使用的放射信息系统程序，称为 Coral RIS/PACS。
由于人员配置问题和排班不一致，床边 PICC 操作的年度总量从 2012 年的 45 例增加到 2018 年的 486 例。2017 年进行程序更改后，床边 PICC 操作的总量为 382 例，而 2018 年则达到了更为显著的 486 例。在这两年中，通过分析单独由技师完成的床边 PICC 数量，对该计划进行了评估。两年均实现了总体成功：2017 年，82%的病例由技师单独完成，无需任何协助，2018 年同样为 89%。
自从开展这一流程改进倡议以来，我们机构的介入放射科医生监督下的 MRT 床边 PICC 计划使许多患者和医院受益。在计划的开发过程中，明显的是，定期安排经过培训且敬业的 MRT 定期进行这些床边操作，提高了该计划的效率。
