Nurses’ Attitudes and Knowledge of Peripherally Inserted Central Catheter Maintenance in Primary Hospitals in China: A Cross-Sectional Survey

Figures & data

Table 1 Nurses’ Demographic Characteristics and Their Association with PICC Maintenance Knowledge Score (n=560)

Characteristic	N (%)	Score (x̄±s)	Z/H	P value
Gender			−0.259^a	0.795
Male	533 (95.2)	10.70 ± 2.96
Female	27 (4.8)	11.00 ± 2.79
Age, years			6.506^b	0.089
≤25	132 (23.6)	10.55 ± 2.64
26–35	333 (59.5)	11.03 ± 2.76
36–45	85 (15.2)	11.54 ± 3.09
>45	10 (1.8)	10.50 ± 2.84
Years of nursing experience			49.042^b	<0.001
1–3	119 (21.3)	9.64 ± 2.69
4–5	63 (11.3)	10.13 ± 2.41
6–10	219 (39.1)	11.22 ± 2.59
>10	159 (28.4)	12.01 ± 2.81
Professional titles			44.183^b	<0.001
Nurse	160 (28.6)	9.97 ± 2.68
Senior nurse	263 (47.0)	10.97 ± 2.69
Supervisor nurse	124 (22.1)	12.15 ± 2.66
Co-chief nurse and above	13 (2.3)	12.69 ± 2.63
Education levels			11.171^b	0.004**
Technical secondary school	4 (0.7)	10.00 ± 1.41
Junior college	196 (35.0)	10.45 ± 2.74
Undergraduate	360 (64.3)	11.29 ± 2.79
Work settings			−6.735^a	<0.001
Community hospital	227 (40.5)	11.93 ± 2.97
Township hospital	333 (59.5)	10.34 ± 2.47
Departments			33.635^b	<0.001
Oncology department	181 (32.3)	11.91 ± 3.02
Internal medicine department	259 (46.3)	10.65 ± 2.50
Surgery department	50 (8.9)	10.54 ± 2.79
Gynecology and obstetrics department	38 (6.8)	9.92 ± 2.57
Orthopedics department	32 (5.7)	10.41 ± 2.77
Whether PICC maintenance training was obtained before?			−5.344^a	<0.001
No	264 (47.1)	10.31 ± 2.51
Yes	296 (52.9)	11.58 ± 2.90
Whether PICC catheterization certification had been gained?			−4.239^a	<0.001
No	494 (88.2)	10.78 ± 2.60
Yes	66 (11.8)	12.52 ± 3.63

Notes: ^aZ value; ^bH value; **P<0.01.

Abbreviations: PICC, peripherally inserted central catheter; N, number.

Table 2 Attitudes Toward PICC Maintenance (n=560)

Items	Strongly Disagree/Disagree, N (%)	Neither Disagree Nor Agree, N (%)	Strongly Agree/Agree, N (%)
1. Patients with PICC need regular catheter maintenance during both the treatment period and the treatment intermission.	1 (0.2)	17 (3.0)	542 (96.8)
2. There is a correlation between indwelling time and the timely and correct PICC maintenance.	11 (2.0)	40 (7.1)	509 (90.9)
3. Timely and correct PICC maintenance can reduce the occurrence of PICC related complications.	1 (0.2)	24 (4.3)	535 (95.5)
4. PICC maintenance needs to be performed according to a standardized process.	1 (0.2)	13 (2.3)	546 (97.5)
5. Strict aseptic procedures in the process of PICC maintenance is essential to prevent PICC-related infections.	1 (0.2)	7 (1.2)	552 (98.6)
6. Choosing the right disinfectant and disinfection range is important to prevent PICC-related infections.	1 (0.2)	19 (3.4)	540 (96.4)
7. Using the correct flushing and locking techniques is essential to prevent PICC occlusion.	1 (0.2)	22 (3.9)	537 (95.9)
8. A comprehensive and systematic catheter function assessment contributes to the early identification of PICC-related complications.	2 (0.4)	23 (4.1)	535 (95.5)
9. Effective health education for patients with PICC contributes to PICC self-management.	7 (1.2)	11 (2.0)	542 (96.8)
10. Nurses in primary hospitals are also responsible to provide education on PICC daily management for patients with PICC and their caregivers.	20 (3.6)	31 (5.5)	509 (90.9)
11. Nurses in primary hospitals can play an important role in catheter maintenance for discharged patients with PICC.	23 (4.1)	64 (11.4)	473 (84.5)
12. It’s necessary for nurses in primary hospitals to master the knowledge of PICC maintenance and complication management.	5 (0.9)	29 (5.2)	526 (93.9)
13. Nurses in primary hospitals need to master the PICC maintenance technique to better meet the needs of discharged patients with PICC.	4 (0.7)	22 (3.9)	534 (95.4)
14. Participation in PICC maintenance training is important for nurses in primary hospitals to improve relevant knowledge and skills.	3 (0.5)	20 (3.6)	537 (95.9)
15. PICC maintenance training should be conducted regularly in primary hospitals.	1 (0.2)	41 (7.3)	518 (92.5)
16. I am interested in learning knowledge of PICC maintenance.	7 (1.3)	46 (8.2)	507 (90.5)
17. I am willing to take an active part in PICC maintenance training.	1 (0.2)	38 (6.8)	521 (93.0)

Note: The 5-point Likert scale results were collapsed into strongly disagree/disagree, neither disagree nor agree, and strongly agree/agree.

Abbreviations: PICC, peripherally inserted central catheters; N, number.

Table 3 Number and Proportion of Correct Responses to Items of PICC Maintenance Knowledge (n=560)

Items	Number	Proportion (%)
1. Which of the following is the content of PICC maintenance?	539	96.25
2. Which of the following are the preferred disinfectant and correct disinfection range for skin disinfection when replacing the dressing?	40	7.14
3. Which of the following is the incorrect method of tearing the film when replacing it?	283	50.54
4. Which of the following is the wrong time to replace the transparent dressing and infusion connector?	316	56.43
5. Which of the following is the incorrect method of sterilizing the spiral part when replacing the infusion connector?	117	20.89
6. What type of flushing fluid should be used after the infusion of blood products and fat emulsions? And what is the minimum volume?	147	26.25
7. Which of the following is the correct type and volume of sealing fluid when maintaining PICCs?	121	21.61
8. What kind of techniques should be used for tube flushing and locking when maintaining PICCs?	464	82.86
9. Which of the following is the incorrect intervention if PICC is accidentally completely dislodged?	473	84.46
10. Which of the following is the correct intervention for PICC occlusion?	392	70.00
11. Which of the following is the preferred auxiliary examination for PICC-related thrombosis?	390	69.64
12. Which of the following is the correct preventive measure for PICC-related infections?	530	94.64
13. Which of the following is the incorrect intervention for PICC breakage in vitro?	370	66.07
14. which of the following is the first intervention for PICC breakage in vivo?	318	56.79
15. Which of the following is the incorrect intervention for phlebitis?	323	57.68
16. Which of the following is the correct intervention for contact dermatitis?	306	54.64
17. Which of the following is not true related to health education for discharged patients with PICC?	313	55.89
18. Which of the following is the wrong operation when removing the PICC?	509	90.89
19. If the patient suddenly develops signs and symptoms such as dyspnea, chest pain, hypotension, dysphoria, and sweating in the process of PICC removal, which of the following is the incorrect intervention?	201	35.89

Abbreviation: PICC, peripherally inserted central catheter.

Table 4 The Generalized Linear Model of the Factors Influencing PICC Maintenance Knowledge (n=560)

Factors	B	SE	95% Wald CI		Wald χ^2	P value
			Lower	Upper
Years of nursing experience
1–3	0
4–5	0.06	0.0393	−0.017	0.137	2.365	0.124
6–10	0.146	0.0353	0.077	0.215	17.091	<0.001
>10	0.144	0.0385	0.069	0.22	14.062	<0.001
Professional titles
Nurse	0
Senior nurse	0.026	0.031	−0.035	0.086	0.684	0.408
Supervisor nurse	0.102	0.0376	0.028	0.176	7.379	0.007**
Co-chief nurse	0.08	0.0768	−0.071	0.23	1.078	0.299
Education levels
Technical secondary school	0
Junior college	−0.027	0.1222	−0.267	0.212	0.051	0.822
Undergraduate	−0.014	0.122	−0.254	0.225	0.014	0.906
Work settings
Community hospital	0
Township hospital	−0.17	0.0251	−0.219	−0.12	45.72	<0.001
Departments
Oncology department	.000
Internal medicine department	0.028	0.0274	−0.026	0.081	1.022	0.312
Surgery department	−0.088	0.039	−0.164	−0.011	5.041	0.025*
Gynecology and obstetrics department	−0.058	0.0446	−0.145	0.03	1.676	0.195
Orthopedics department	−0.167	0.0474	−0.259	−0.074	12.379	<0.001
Whether PICC maintenance training was obtained before?
No	0
Yes	0.038	0.0221	−0.006	0.081	2.896	0.089
Whether PICC catheterization certification had been gained?
No	0
Yes	0.025	0.0343	−0.042	0.092	0.537	0.464

Notes: **P<0.01; *P<0.05. The independent variables in the generalized liner model were coadded as the following: Years of nursing experience (1–3=1, 4–5=2, 6–10=3, >10=4), Professional titles (Nurse=1, Senior nurse=2, Supervisor nurse=3, Co-chief nurse=4), Education levels (Technical secondary school=1, Junior college=2, Undergraduate=3), Work settings (Community hospital=1, Township hospital=2), Departments (Oncology department=1, Internal medicine department=2, Surgery department=3, Gynecology and obstetrics department=4, Orthopedics department=5), Whether PICC maintenance training was obtained before?(No=0, Yes=1), Whether PICC catheterization certification had been gained?(No=0, Yes=1).

Abbreviation: PICC, peripherally inserted central catheter.