The purpose of this study was to test the use of an electronic tablet as a tool to provide coaching to newly diagnosed cancer patients for peripherally inserted central catheter (PICC) maintenance to minimize infection and occlusion complications. PICC occlusion and infection often occur because of poor maintenance techniques, specifically inadequate aseptic techniques when manipulating the line, failing to flush lines properly, and/or not using the locking solution recommended for a specific device. (Ferroni et al., 2014). Using the pulsatile flushing technique with normal saline is a simple and effective technique to create turbulence inside the line to prevent catheter occlusion and decrease bacterial colonization (Camp-Sorrell, 2011, Ferroni et al., 2014, INS, 2016). Effective patient and caregiver education is necessary to ensure infusion therapy safety and decrease the risk of PICC-related complications (INS, 2016). Patients and caregivers must be able to perform the tasks of PICC maintenance and know when to contact a healthcare provider if complications arise. Management of PICCs, as well as patient and family education using electronic tablets, is in the scope of nursing practice and the standards of practice for the Oncology Nursing Society (ONS) and Infusion Nurses’ Society (INS). The INS (2016) recommended guidelines for patient/caregiver education for PICCs include device description, reason for placement, aseptic technique, basic device flushing, dressing and injection cap change, level of discomfort the patient may experience, site assessment for adverse outcome symptoms, potential complications, along with prevention and management of complications. As healthcare costs continue to escalate and home care benefits are being reduced, this study has significance to nursing. Patients who learn about self-care at home, away from the distractions of the healthcare environment, can be more involved in their care. By shifting the learning environment to the patients’ homes or environments of choice, the intervention can take place in a patient-controlled environment. Integrating technology into healthcare practices can provide an innovative way to assist patients and nurses manage complex health conditions. Because of the volume and complexity of the information, patients have described self-care education as unhelpful, excessive, and frightening (Coffey et al., 2016). Patients feel overwhelmed and, therefore, their retention of this critical information is severely limited (INS, 2016; Coffey et al., 2016).
Methods: This study proposed a new strategy for patient and caregiver education – a comprehensive educational intervention using electronic tablets to reduce the incidence of PICC line occlusion and infection in the adult outpatient population. Combining technology and educational theory can provide repetition and self-paced learning for patients who are learning self-care techniques to manage their PICC lines. Using an electronic tablet to detail the steps required for flushing their PICC lines could help patients master the process better than receiving the standard method of patient education. The researcher had created the video for flushing PICC lines and uploaded it to YouTube. Therefore, the intervention for this project was a coaching session with the researcher who is an infusion nurse, along with providing the patient with a video on an electronic tablet that outlined the steps of flushing. The tablet was taken home to provide a demonstration that could be replayed as needed. In addition, a nurse could use voice and audio calls, such as Facetime or Skype, to coach the patient through the process. It was believed that as patients became more proficient at flushing their PICC lines, the negative outcomes of occlusion and infection should be minimized. To determine the efficacy of using electronic tablets as an instructional delivery method for patient and caregiver education, a pilot study was conducted.
Results: A sample of 11 newly diagnosed cancer patients were asked to participate in the study. The ages of the subjects ranged from 38 to 88 years old, with a mean age of 66.64 (SD = 13.37) years. Four participants (36.4%) were female and seven (63.6%) were male. Of the 11 patients who were initially enrolled in the study, leukemia was the most frequent diagnosis (3), ovarian (2) and pancreatic (2) cancers and 1 participant each with breast, bone, stomach or lung cancers. After reviewing the informed consent form with the researcher, they completed a short demographic survey. The patients and their caregivers met with an infusion nurse who provided the standard education on flushing their PICC lines. They then met with the researcher who instructed them on using a tablet to access YouTube and Facetime applications. Each patient was sent home with an electronic tablet. Shortly after, the researcher contacted the patient/caregiver to provide interactive coaching on flushing their PICCs. The patients/caregivers were encouraged to contact the researcher if they encountered any difficulties when flushing their PICC lines. The infusion nurses at the clinic where they were receiving treatment monitored the infection and occlusion rates for the 11 patients. None of the patients experienced infection or occlusion complications with their PICC lines, although one patient experienced thrombophlebitis, which required removal of the PICC line. There were no occlusive outcomes in the pilot study participants. The national reported PICC occlusion rates varied from 14 to 36% (Barrier et al., 2013; Dougherty, 2014). There were no PICC line associated infections in the pilot study participants. The national reported PICC line associated infection rate in outpatients was 0.5% (Chopra et al., 2013). The outcomes for occlusion and infection in the study population were better than outcomes in national samples.
Conclusion:
Previous research has demonstrated that electronic platforms for patient education improve interactive capabilities and support communication needs beyond the outpatient setting (Sawyer et al., 2016). The pilot study of oncology patients with newly inserted PICC lines demonstrated the positive effects of the use of technology to provide remote patient education and coaching in decreasing adverse patient outcomes of PICC occlusion and infection. Developing applications for electronic tables and smart phones to help with patient education can help overcome some of the visual and auditory problems associated with printed materials. The use of an electronic tablet to provide this type of education while the patient and caregiver are in their home environment can provide opportunities for coaching, reviewing, and reinforcing self-care treatments that can improve health outcomes.
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