الفهرس 
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Abstract
Summary
The peripherally inserted central catheters (PICCs) allows for reliable route of administration for intravenous nutrition and medications (Hunt, 2022). Although they were originally developed for delivery of parenteral nutrition, but the use of PICCs has been expanded to include chemotherapy administration, long-term intravenous (IV) antibiotic treatment, and venous access when obtaining peripheral veins is difficult such as occluded peripheral veins, unusual venous anatomies (Wilson et al., 2018).
At Neonatal Intensive Care Unit (NICU) the use of PICCs considered as a one of new technologies that increased life span of the newborns, taking into consideration that neonatal co-morbidity and mortality has a direct effect on the preterm (gestational age less than 37 weeks) and the newly born with low body weight (less than 2,5 kg) (Bhargava, et al., 2020).
Aim of the study
The study was aimed to assess the nurse’s performance toward peripherally inserted central venous catheters in Neonatal Intensive Care Unit through:
Assess nurse’s knowledge related to peripherally inserted central venous catheters.
Assess nurse’s practice related to peripherally inserted central venous catheters.
Assess nurse’s attitude related to peripherally inserted central venous catheters.
Research Questions
What are the nurse’s level of knowledge and practice regarding peripherally inserted central venous catheters in Neonatal Intensive Care Unit?
What are nurse’s attitude regarding peripherally inserted central venous catheters in Neonatal Intensive Care Unit?
Are there relation between nurse’s knowledge, practice, attitude and their characteristics towards peripherally inserted central venous catheters in Neonatal Intensive Care Unit?
Are there a relation between total nurse’s knowledge, practices and their attitude regarding peripherally inserted central venous catheters in Neonatal Intensive Care Unit?
Subjects & Methods
Research design:
A descriptive design was utilized to achieve the aim of this study.
Study Setting:
This study was conducted at both hospitals the Neonatal Intensive Care Units (NICUs) at Maternity / Gynecological Hospitals and Children’s Hospital affiliated to Ain Shams University Hospitals.
Subjects
A convenient sample composed of 60 nurses who provided direct care for neonates undergoing peripherally inserted central venous catheter in neonatal intensive care units from above mentioned setting, 40 nurse from Maternity Hospital and 20 nurse from Children’s Hospital under the following inclusion criteria nurses who provide direct care for neonates undergoing peripherally inserted central venous catheter, their experience more than three months in the unit.
- A purposive sample composed of 60 neonates with gestational age less than 37 week of gestation, birth weight less than 2500 gm. and undergoing peripherally inserted central venous catheter in the time of data collection:
Sample size:
n= (N×P(1-P))/([N-1×(d2÷z2)]+p(1+p))
n=sample size
z=the statement score
d=the error rate
p=property availability and natural ratio
N=size of population
Tools of data collection
Data was collected through using the following tools:
Tool I: Pre-designed Questionnaire
It was designed by the researcher based on recent review and includes parts.
Part I: A) characteristics of studied subjects (7 questions). It includes: age, level of education, gender, years of experience, marital status, training courses….. etc.
B) characteristics of infant neonates (9 questions), such as gestational age, gender, chronological age, diagnosis, birth weight, date of admission, site of insertion, time of insertion, of peripherally inserted central catheters.
Part II: It was related to Nurses’ knowledge regarding PICC (peripherally inserted central catheter) line. It will be composed of (27 question) about meaning of the peripherally inserted central catheters, indications, most common insertion sites, and precaution during insertion, nursing role during preparation, side effect, contraindication, care of peripherally inserted central catheters, how to prevent and deal with catheter occlusion, complications, time of catheter changed, catheter removal and prevention of its complications.
Scoring system: It was scored as following:
The right complete answer was scored as two point, one for incomplete, wrong answer was scored as a zero. These scores were summed and converted into a percentage scores.
Total scoring was classified into 3 categories:
Good knowledge if score ≥75%.
Average knowledge if score from 60 to less than 75%.
Poor knowledge if score < 60%.
Part III: Observational checklists toward peripherally inserted central venous catheters (PICC)
It was designed after reviewing related literature based on peripherally inserted central catheters insertion and care observational checklist .It was adopted from Bowden, Greenberg, (2016), Westergaard, Classen, & WALTHER‐LARSEN (2013), and Delarbre, et al. (2014), and also observation checklists adapted from Perry, & Potter, (2014), Noaman, et al., (2019) was used to assess the nurses’ practices about caring of neonatal infant, the insertion technique, PICC site care and dressing change, maintaining patency of the PICC and removal technique.
Scoring system: A scoring system will be followed to assess nurses’ practices; each checklist will be assigned a score according to its sub-items. The items will be assessed as done will be scored one grade and not done will be scored zero. These scores will be summed up and will be converted into a percentage score and according total scoring will be classified into 2 categories:
Competent if score ≥ 85% (33 grade)
Incompetent if score <85% (33 grade)
Tool II: Attitude assessment Scale:
It adapted from (Binbin et al., 2020) to assess attitudes regarding the peripherally inserted central venous catheters (PICC) in neonatal intensive care unit. It was consisted of 23 items. Such as preparation process, type of hand hygiene, sterilization materials and time needed for hup scrubbing, infection prevention protocols.
Scoring system: A scoring system was followed to assess nurses’ attitudes toward peripherally inserted central venous catheters (PICC). Each statement of scale was assessed nurses’ responses and classified as agree, uncertain, disagree and was respectively scored 2 for agree, 1 for uncertain, zero for disagree; the scores of the items were summed up and total scoring was classified into two categories:
Positive attitude if score ≥ 32%.
Negative attitude if score < 32%.
The most important results of the study can be summarized of the following:
The mean age of studied nurses was 28.65±4.51 years, and near to three quarter (73.3%) of them were female and 33.3% had diploma in nursing and bachelor degree.
The mean gestational age of newborn/weeks was 37.31±1.47 weeks, more than half (53.3%) of them were female and more than one quarter (25.7%) of newborn their birth weight between 2000 to 2500gm, with mean 2000± 846 gm.
It was found that (43.3% & 46.7%) of nurses were incomplete answer about meaning and importance of peripherally inserted central venous catheter and 55% of them were incomplete answer about catheter threaded & transfer of medicines and solutions help from its efficiency.
Less than half (48.3%) of studied nurses were didn’t know and incomplete answer about what should be done when resistance during intra catheter injection. 48.4% & 43.3% of studied nurses were incomplete answer regarding time for change, signs indicates total obstruction and length of stay the peripherally intravenous catheter respectively.
More than half (53.3%) of the studied nurses had incomplete answer about technique for confirmed the catheter placement.
Moreover, 48.3% of studied nurses were incomplete answer about determine the locations and role of nurse during the installation of the PICC.
Less than half (48.3%) of the studied nurses had incomplete knowledge about rules of infection control, and steps done before insertion of PICC.
About 70% of the studied nurses were didn’t washing their hands, more than two thirds (68.3%) of the studied nurses didn’t check the vital signs.
Nearly to three quarters of studied nurses (70%& 73.3%) didn’t perform assessment of neonate’s vital signs and O2 saturation, more than half (56.7%) of studied nurses didn’t placing the infant on supine position and selected appropriate vein for PICC insertion.
More than three quarters of studied nurses (76.7%) didn’t close monitoring of the vital signs. Also, more than two thirds (70% & 65%) of studied nurses didn’t observing the catheter site and the area around it for any swelling or redness and maintaining aseptic technique connecting, disconnecting, injection and transfusion to PICC.
Moreover 60% of them didn’t using aseptic techniques during changing dressing of the catheter.
More than two thirds (66.7% & 65%) of the studied nurses had incompetent total practice regarding intravenous infusion and PICC care during insertion,
About 70% of nurses had incompetent total practices regarding care before insertion (PICC).
More than two thirds (68.3%) of studied nurses had incompetent level of total practices. While, 31.7% of them had competent level of total practices
About 56.7% of studied nurses were uncertain about care before and after PICC fixation have positive impact on neonate status.
More than two thirds (65%) of nurses were uncertain about any qualified nurse can keep PICC in place. Furthermore, 38.3% of studied nurses were disagreeing about observation of complication increase nurse awareness and decrease danger. While, 36.7% of them were agree about using the correct flushing and locking techniques is essential to prevent PICC occlusion.
More than half (51.7% & 58.4%) of nurses were uncertain neonates with PICC need regular catheter maintenance during both the treatment period and treatment intermission and respect and answering family questions.
More than half (56.7%, 51.7% & 53.3%) of studied nurses were uncertain about time and correct PICC maintenance.
Approximately two thirds (63.3%) of studied nurses were uncertain about PICC maintenance training should be conducted regularly in primary hospitals
There was no statistical significant difference between total practice and the nurses’ age. While, there was a statistical significant differences between total nurses’ practices and their social status, years of experiences and attending courses.
There was highly statistical significant difference between the nurses’ total practice and their gender and qualification gender.
There was a highly statistical significant differences between studied nurses total attitudes and nurses’ years of experiences
There was a statistical significant difference between total attitudes and studied nurses qualification and social status.
There was no statistical significant difference between total practice and the nurses’ age and attending courses.
There were significant statistical positive correlations between total attitude and the following practice dimensions: Care before insertion (r=.374, p=.001), PICC care during insertion (r=.678, p=.000), care after insertion procedures (r=.384, p=.001), care for pulse oximeters (r=.383, p=.001).
Conclusion: The study clarified that there was statistically significant relation between total knowledge, total practice, total attitude and their characteristics as regards: gender, qualification, social status, years of experience and attending courses about caring of neonates with PICC. Also there was a statistical significant positive correlation between total nurses’ knowledge, practice and attitude.
Recommendations: the following recommendations were suggested:
Establish in-service training programs for continuous updating nurses’ knowledge about PICC, providing on job training programs for staff nurses about peripherally inserted central catheter (PICC).
Further studies should be replicated in different hospitals setting to generalized the results.
Develop a standard protocol for peripherally inserted central catheter.