6456 Reducing the time from clinician decision for a PICC line to PICC line insertion in a district general hospital: a QI project

Objectives Some children require prolonged courses of antibiotics for infections with typical courses lasting from 2 -12 weeks. PICC lines provide medium to long-term access to avoid repeated cannulation and facilitate ambulatory care.¹ Our local unit, a district general hospital, experienced incidents of significant delay in organising PICC insertion both locally and via tertiary centres, and a QI process was initiated to explore reasons for this and improve standard of care. Methods Patient data was retrospectively audited from January 2019 to November 2020, and collected prospectively thereafter. We sought advice from specialist paediatric vascular access services and contacted our local adult vascular access team to learn best practice and to seek to utilise their skills in children. We used the QI process to agree the key aim: to reduce the time from clinician decision for PICC line insertion to line insertion to <3 days. Based on this aim, we collaborated on a driver diagram. Key elements were identified, which included recognising a limited pool of suitably skilled staff, no formalised guideline for procedural sedation, and no clear pathway for referral. We then implemented PDSA cycles which led to the creation of a referral pathway, vascular access nurses supported to insert PICC lines in children, and a guideline for sedation for painful procedures. Results 24 PICC lines were inserted in the period of study over 4 years. Prior to our interventions the median number of days between decision and insertion was 1, with 67% of children achieving line insertion in <3 days (9/12 cases), with range 1–27 days. After our interventions the median number of days between decision and insertion was 1, and 92% (11/12 cases) has their line inserted within 3 days, with range 1- 6 days (figure 1). The pool of local staff inserting PICC lines increased during the project (figure 2), including vascular access nurse, interventional radiologist and physician associate supervised by a paediatrician. Conclusion We have established interventions which appear to have decreased variations in time to PICC line provision and increased the pool of staff available to insert PICC lines. However our local paediatric and vascular access team are not commissioned for dedicated time to maintain continuity of service; this combined with staff turnover and unpredictable infrequent case load mean that maintaining a consistent service is difficult. Reference Westergaard B, Classen V, Walther-Larsen S. Peripherally inserted central catheters in infants and children – indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand. 2013 Mar.