Picking the right PICC for patients, staff
What to look for when it’s time to shop
Maybe you’re hearing complaints from nurses. Maybe a peer told you about another PICC. Or maybe you just want to get an idea of what’s available on the market.
Whatever reason you decide to shop for a new PICC, there’s definitely a right and a wrong way to go about it. Although cost is an issue, there are many other aspects to choose a PICC. (See chart, p. 16.)
Nancy Moureau, BSN, CRNI, and president of PICC Excellence in Orange Park, FL, says there are three broad areas she suggests home infusion providers consider when shopping for PICCs: features, price, and support.
CDC sets guidelines
It’s important to note that all three come under what the Centers for Disease Control and Prevention (CDC) recommend in its Guideline for Prevention of Intravascular-Device-Related Infections:
"Select a device with the lowest relative risk of complications (infectious vs. noninfectious) and the lowest costs for the anticipated type and duration of IV therapy. The risk and benefits of replacing a device at a recommended schedule to reduce infectious complications should be weighed against the risk of mechanical complications and availability of alternative sites."1
1. Features
"There are certain features that I encourage people to look for," says Moureau. "These are all benefits, but they are not requirements."
• Reinforced extension sets cut down on breakage.
Extension sets aren’t all you should consider. Also look at the catheter wall itself, says Lynn Hadaway, MEd, RNC, CRNI and principal of Hadaway and Associates, an infusion therapy consulting firm based in Milner, GA.
"Look for information about the tensile strength and the amount of pressure the catheter can tolerate," she says. "Injection from small syringes, catheters that are partially or completely occluded from blood or drug precipitate and undue amounts of stress such as sudden pulls or getting caught on clothing or a door present situations where a strong catheter is needed."
• Size of introducers, specifically the smallest introducer size that will accommodate the largest catheter.
• Flow-through guidewire, which allows the user to check for blood return during insertion with a guidewire in place.
• Hydrophilic guidewire to reduce stuck guidewire problems.
• Valved hub or closed ended catheters reduce the risk of air emboli.
• Guide markings with numbers on the catheter.
• Catheter material (polyurethane or silicone or some other impregnated polymer).
• Clamp on the catheter.
These are all plusses, not requirements, according to Moureau.
Darnell Roth, CRNI, president of D/R Intravenous Therapy Consulting, of St. Louis, adds several other features to the list.
• Insertion tray with everything needed for safe insertion.
"Some clinicians prefer the breakaway needle over the peelaway sheath, so they need to know if both are available rather than having just one, which will limit the staff and make some of them uncomfortable," she says.
Other features include safety factors such as devices that protect staff, patients, and caregivers from needlesticks.
Hadaway says you should also consider catheter length, particularly if you do not believe that cutting catheters has been proven safe.
Lastly, look at the insertion tray.
"There are a variety of components required for a safe insertion that should be included in the insertion tray," she says. "You should place a big emphasis on the size of the drapes and whether a gown is provided."
The tray should also include a repair kit for the temporary repair of any device should you need it while in the home.
2. Price
Most cost from $50 to $80, depending on the kit, according to Moureau, although she points out that Bard’s Groshong valved catheter costs more than $80.
"It’s a patented device and they charge more for it," says Moureau.
Make sure you shop around. Moureau notes that many providers end up paying too much because they haven’t looked at all the available products and compared price.
Roth cautions against giving cost too much consideration.
"Cost is a consideration as long as the cost factor does not compromise quality," she says.
3. Support
Switching to a new PICC is difficult enough considering the time involved and the re-training of staff once you make the move. The last thing you want is a manufacturer that leaves you high and dry. Moureau notes that there are certain aspects of support you should be able to expect from the manufacturer/distributor.
• Easy accessibility for questions.
"For general questions about the product, you should be able to expect a 24-hour call back from your sales rep," says Moureau. "If the sales rep is difficult to talk to and to get in touch with, that’s not a value."
• Literature support.
Make sure you are given plenty of advertising material and product information up front. Having such information in front of you will assist you when making comparisons between catheters. This should also include reference information such as articles supporting the use of and safety of the catheter.
• Clinical support.
"The clinical component would be troubleshooting and consultation services on a case-by-case basis when there is a specific problem," according to Hadaway.
Along those lines, Moureau says in such situations you should be able to count on getting a call back within four hours with an answer to any problem or difficulty you may be having with the catheter.
• Education support.
Initial as well as ongoing education is a real plus and should be factored in as a benefit.
"That’s very important for PICC lines," says Moureau. "Staff can’t use a product unless each nurse is trained to use the product correctly. When staff is properly trained, there is lower liability for the distributor and manufacturer."
Moureau notes that, as with any business, the adage You get what you pay for’ holds true.
"Don’t expect the manufacturer to provide everything for free," she says. "Assistance and facilitation is enough."
"There is also the continuing education piece necessary to take a person without any experience placing these lines and providing them with the CE as part of the qualification process," says Hadaway.
Roth points out that some manufacturers offer videos on insertion and management that can become part of a provider’s reference material. Moureau adds you may have to ask to find out what is available, as some manufacturers don’t provide such materials without a request.
Most manufacturers have care and maintenance posters, training manuals, CDC tip sheets, utilization programs, standing order forms, literature libraries, and a host of other helpful materials available to users.
The last word
Moureau notes even after all of your homework, there’s only one way to make sure you’ll be happy with your choice: Take it for a test drive. One of the most common mistakes she sees is people buying on nothing more than written literature and sales pitches.
"Don’t buy without a trial, and try several products out for a comparison," she says. "Of the 14 or so PICC products available on the market, choose the best for you and your patients, not just the one on the contract. Frequently, the smaller PICC manufacturers’ price will be less than the contracted PICC company price."
Hadaway notes that some manufacturers may not provide free samples but may offer a money-back guarantee if you are not satisfied. Either way, be sure to take the PICCs for a test drive.
Reference
1. Pearson ML, Hospital Infection Control Advisory Committee. Guideline for Prevention of Intravascular-Device-Related Infections. Infection Control Hosp Epidemiol 1996; 17:438-473.
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