Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
J Vasc Access. 2024 Sep;25(5):1601-1609. doi: 10.1177/11297298231173160. Epub 2023 Jun 21.
Nurse-led peripherally inserted central venous catheter (PICC) placement teams are common in western hospitals, but they are still in their infancy in Japan. Although implementing a dedicated program may improve ongoing vascular-access management, the direct hospital-level effects of launching a nurse-led PICC team on specific outcomes have not been formally investigated.
To evaluate the effect of introducing a nurse practitioner (NP)-led PICC-placement program on subsequent utilization of centrally inserted central catheters (CICCs) and to contrast the quality of PICC placements conducted by physicians and NPs.
Patients who underwent central venous access devices (CVADs) between 2014 and 2020 at a university hospital in Japan were evaluated retrospectively using an interrupted time-series analysis on the trend for monthly CVAD utilization and logistic regression and propensity score-based analyses for PICC-related complications.
Among 6007 CVAD placements, 2230 PICCs were inserted into 1658 patients (725 by physicians and 1505 by NPs). The monthly number of CICC utilization fell from 58 in April 2014 to 38 in March 2020, while PICC placements by the NP PICC team increased from 0 to 104. The implementation of the NP PICC program reduced the immediate rate (by 35.5; 95% confidence interval [CI]: 24.1-46.9; < 0.001) and post-intervention trend (by 2.3; 95% CI: 1.1-3.5; < 0.001) of monthly CICC utilization. Overall immediate complication rates were lower in the NP group than the physician group (1.5% vs 5.1%; adjusted odds ratio = 0.31; 95% CI: 0.17-0.59; < 0.001). The cumulative incidences of central line-associated bloodstream infections were comparable between the NP and physician groups (5.9% vs 7.2%; adjusted hazard ratio = 0.96; 95% CI: 0.53-1.75; = .90).
This NP-led PICC program reduced CICC utilization without affecting the quality of PICC placement or complication rate.
在西方医院，护士主导的经外周中心静脉置管（PICC）团队很常见，但在日本，这种团队仍处于起步阶段。尽管实施专门的计划可能会改善现有的血管通路管理，但启动护士主导的 PICC 团队对特定结果的直接医院层面影响尚未得到正式调查。
评估引入执业护士（NP）主导的 PICC 置管计划对随后使用中心静脉置管（CICC）的影响，并对比医生和 NP 进行 PICC 置管的质量。
回顾性分析了一家日本大学医院 2014 年至 2020 年期间进行的中心静脉血管通路装置（CVAD），采用月度 CVAD 使用趋势的中断时间序列分析、逻辑回归和基于倾向评分的分析来评估 PICC 相关并发症。
在 6007 例 CVAD 置管中，2230 例 PICC 被置入 1658 例患者（725 例由医生进行，1505 例由 NP 进行）。CICC 的每月使用量从 2014 年 4 月的 58 例降至 2020 年 3 月的 38 例，而 NP PICC 团队的 PICC 置管量从 0 例增至 104 例。NP PICC 项目的实施降低了 CICC 使用率的即时率（降低了 35.5%；95%置信区间[CI]：24.1-46.9； < 0.001）和干预后趋势（降低了 2.3%；95%CI：1.1-3.5； < 0.001）。NP 组的总体即时并发症发生率低于医生组（1.5%比 5.1%；调整后的优势比 = 0.31；95%CI：0.17-0.59； < 0.001）。NP 组和医生组的中心静脉相关血流感染累积发生率相当（5.9%比 7.2%；调整后的危险比 = 0.96；95%CI：0.53-1.75； = 0.90）。
该 NP 主导的 PICC 计划减少了 CICC 的使用，同时不影响 PICC 置管的质量或并发症发生率。
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