Tools and resources

Adoption support resource – insights from the NHS

6 How to implement NICE's guidance on SecurAcath

6 How to implement NICE's guidance on SecurAcath

The experiences of contributors have been used to develop practical suggestions on how to implement the NICE guidance on SecurAcath. Local organisations will need to assess the applicability of the learning from the examples of current practice, taking into consideration the time, resources and costs of an implementation programme. To implement this technology into routine practice, contributors to the resource suggest the following steps.

Project management

This technology can be best adopted using a project management approach. NICE has produced the into practice guide, which includes a section on what organisations need to have in place to support the implementation of NICE guidance.

Implementation team

The first step is to form a local project team who will work together to implement the technology and manage any changes in practice.

Individual NHS organisations will determine the membership of this team and how long the project will last. Consider the following membership of the team so that the guidance is implemented in an effective and sustainable way:

  • Clinical champion: they could be a senior clinician or manager with an interest in IV access, and should have the relevant knowledge and understanding to be able to drive the project, answer any clinical queries and champion the project at a senior level.

  • Project manager: they could be someone in a clinical or managerial role who will be responsible for the day-to-day running of the project, co‑ordinating the project team and ensuring the project is running as planned.

  • Management sponsor: they will be able to help assess the financial viability of the project, ensure the business case is prepared and help to show the cost savings achieved.

  • Procurement team: they will be able to assist with negotiations for a high volume and low cost item.

  • Anaesthetists: they may be interested in implementing the technology concurrently in critical care for non-tunnelled central venous catheters.

  • Interventional radiologists: the implementation of the technology may be of interest to them as they may be providing the service.

  • Clinical audit facilitator: they will be able to help set up systems to collect and analyse local data needed to measure the project's performance and carry out audits.

Assessment of readiness

Questions the project team may wish to consider when preparing to adopt this technology are:

  • Will a pilot period be helpful?

  • How will project performance measures at a local level be identified and implemented?

  • Who will be responsible for collecting clinical data?

  • How will the training needed for insertion and removal be provided?

  • How can effective communication be ensured?

  • Are there any obvious challenges and how can these be overcome?

Resource impact

NICE has published a resource impact report and template that can be used by NHS commissioners and providers to better understand the local costs associated with adopting SecurAcath. The national assumptions used in the template can be altered to reflect local circumstances.

NICE estimates that around 128,000 people in England with peripherally inserted central catheters (PICCs) in place for 15 days or more may be eligible for SecurAcath. Uptake will increase over 5 years, with around 121,000 people having SecurAcath in 2021/22 onwards. The minimum annual saving estimated from implementing the guidance is around £4.2 million. This is equivalent to around £7,700 per 100,000 population.

Business case

Producing a business case should be a priority for the implementation team. Local arrangements for developing and approving business plans will vary from trust to trust, and each organisation is likely to have its own process in place.

The business case for SecurAcath should include:

  • NICE and other national guidance:

  • A resource impact assessment (see resource impact).

  • A summary of any proposed pilot studies, evaluations or results of any already completed including criteria reviewed. Contributors suggest criteria could be: ability to insert, ability to attach catheter, ability to close the device, ability to clean around the device at dressing changes, comfort to the patient, data on the number of malpositioned and damaged catheters.

  • Any current and anticipated (following implementation) catheter complication rates such as dislocation, migration, replacements, incidences of deep vein thromboses while PICC is in place, rates of skin complications from medical adhesive devices and site infection rates.

Selecting patient groups

NICE guidance recommends the use of SecurAcath for PICCs with an expected dwell time of 15 days or more. Contributors to this resource highlight 2 groups of patients who would benefit from this technology irrespective of predicted dwell time:

  • Patients presenting with confusion who may be at risk of pulling out the venous catheter.

  • Patients presenting with excessive sweating where other methods of securing percutaneous catheters may be unsuccessful.

One organisation is currently piloting the use of the SecurAcath for all midlines to address increased workload issues presented by winter pressures. Their initial findings indicate that reducing the venous catheter migration and replacement rate by using SecurAcath has resulted in cost savings.

Another contributor now uses SecurAcath for non-tunnelled central venous catheters in critical care following the success of SecurAcath for PICCs in their organisation.

All contributors emphasised the importance of clinical benefit on the decision to implement rather than using the predicted dwell time to make this decision. Replacements rates should also be considered a key factor.

Measuring success

It is important to record a baseline assessment and take measurements during and after implementation to show the cost and clinical benefit of adopting SecurAcath. Sites involved in developing this resource suggested the following measures could be used and that it is important to agree who is responsible for collating and managing these data:

  • catheter migration or dislodgement rates

  • catheter replacement rates

  • catheter site infection rates

  • deep vein thrombosis rates

  • patient experience audits.

Contributors reported the ability to collect these measures will vary depending on service setup, staff resources and information technology.

One service introduced a venous catheter insertion and removal chart for staff to record any difficulties. These charts are sent to the IV therapy nurse consultant who keeps a central record detailing difficulties and reasons for removal. This has enabled a record to be kept for all venous catheters placed.

Incident form reporting is another mechanism by which adverse events can be identified and risks monitored.

Training

All contributors advise that training for insertion, maintenance and removal of SecurAcath is essential, and perseverance is critical.

  • Additional appointment time may be needed at first to ensure correct placement. Practitioners need to become familiar with the device to prevent skin indentation and anchor migration.

  • The company provides face-to-face training and post-implementation support. Contributors found the videos and mobile application for SecurAcath placement and removal to be helpful additions to training (both available on the company's website).

  • An education plan should be in place before implementation and should detail who will need training, and to what level. Consider the fact that a more diverse staff base will be responsible for removing the device than those inserting the technology. Staff who insert the device are generally IV access dedicated practitioners and have more experience with PICCs than staff who remove them.

  • PICC training can be split into 2 levels: PICC level 1 (basic care and maintenance) and PICC level 2 (complication management and advanced techniques such as SecurAcath removal).

  • Clinicians should be accountable for independent placing and removal of SecurAcath following training. SecurAcath should only be placed by practitioners with accountability for placing PICCs and removed by practitioners who have training to do so.

  • Some patients may need local anaesthetic for removal of the device.

    • Identify if a patient group directive for lidocaine exists in the service.

    • If so, ensure appropriately qualified staff are available to administer if needed.

  • Share experiences and watch experienced staff use the device to gather tips and advice.

Practical tips from contributors for successful SecurAcath insertion

  • A few extra centimetres are needed to accommodate SecurAcath. If there is insufficient length this may result in the catheter 'kinking'.

  • Do a surgical nick in the skin below the cannula before the introducer is placed, otherwise the introducer needs to be 'corkscrewed' into position. This nick also allows the tips of the device to be positioned. Although a surgical nick in the skin helps with placement, there is some evidence to suggest that this may increase bleeding at the insertion site and may potentially increase risk of site infection because of a larger breach of the skin. However, these risks are minimal and must be weighed up against the need to safely and correctly place SecurAcath.

  • Push the device in as far as possible and then pull back to ensure it has gone through the dermis layer and is not lying intradermally.

  • Directing the catheter dressed towards the shoulder ensures it doesn't pull down on the device causing discomfort.

  • To avoid indentation beneath the device a gauze dressing placed above and below can act as a cushion to protect the skin.

Practical tips from contributors for successful SecurAcath removal

  • Removal requires a swift pluck in order to remove the device with minimal pain. This takes some time to master.

  • If, for a clinical reason, the PICC needs to be removed but there are no trained staff available to remove SecurAcath, the device can be opened and the PICC removed. The SecurAcath can be removed at a later stage when trained staff are available.

  • Having an algorithm for predicting patients most likely to experience pain on removal has improved the patient experience by prompting the use of local anaesthetic.

Developing local documentation

The following are examples of tools developed by NHS services using SecurAcath, which can be used for developing local documentation. They have not been produced, commissioned or endorsed by NICE:


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