The patient experience of home chemotherapy with a peripherally inserted central catheter (PICC)

1. The patient experience of home chemotherapy with a peripherally inserted central catheter (PICC) Dr Rebecca Sharp School of Nursing and Midwifery Division of Health Sciences

2. Intravenous therapy Cornerstone of contemporary practice Reliable access imperative

3. PICCs Inserted above the ante-cubital fossa region (either arm) terminates SVC Medium term vascular access (weeks-months) Most insertions – RNs with additional training

4. Cancer patients Outpatient treatment • Cost savings • Reduced impact on daily life Variation RN contact

5. Patient experience of a PICC Information - quality and quantity problematic (Oakley et al. 2000; Molloy et al. 2008; Edström 2015). Apprehensive about insertion (Nicholson & Davies 2013)

6. Patient experience of a PICC Satisfaction with the service and ability to be discharged home for treatment (Oakley et al. 2000; Molloy et al. 2008; Harrold, Martin & Scarlett 2016). Initial problems with ADLs when self-managing at home (Molloy et al., 2008; Oakley et al., 2000).

7. Aim Investigate the patient experience of PICC insertion, the significance of arm choice and the impact of the device on activities of daily living.

8. Method Qualitative description Inclusion Participants booked for a PICC in the Radiology department at the Royal Adelaide Hospital Exclusion Unable to provide informed consent

9. Method Semi-structured telephone interviews - 8 weeks post-insertion n=10 (4 cancer patients) Thematic analysis

10. Interview guide

11. Participants *AML= Acute myeloid leukemia; IVAB =intravenous antibiotics

12. Findings • Information provision • Elastomeric pump • Apprehension/Adaptation • Jab,jab, jab

13. Information provision Variation in participants ability to understand information “I didn’t realize the actual piece they put into you went right into your arm across your chest and up to your heart” (45 y.o. with rectal cancer)” Most did not seek clarification “I’m never one to argue with doctors if they’re telling me to do something I know it’s the way” (50 y.o. with testicular cancer)

14. Elastomeric pump Effect of pump on ADLs “… …sometimes you would forget and you just stand up…two worse weeks was when I had one of those bottles..” (45 y.o. Rectal Ca)

15. Apprehension/Adaptation Apprehension Adaptation Limited activity Adverse events

16. Jab, jab, jab All participants described frequent venepuncture attempts PICC= saviour “…personally I think they are one of the greatest inventions ever!..” (46 y.o. with AML)

17. Discussion

18. Information provision

19. Information provision Patient stories

20. Bad veins

21. CR-BSI • Inappropriate removal • Practice change

22. Clinical recommendations - Assess anxiety levels pre-procedure - Assess comprehension of procedure - Provide practical information

24. Thank you and Questions