Fluid optimisation using a peripherally inserted central catheter (PICC) following proximal femoral fracture: Lessons learnt from a feasibility study

Abstract

The aim of this study was to test the feasibility of using peripherally inserted central catheters (PICCs) in older people to enable fluid optimisation. Fourteen patients were randomised to three groups: (i) usual care, insertion of short peripheral intravenous cannulae and normal fluid prescription; (ii) PICC insertion and normal fluid prescription; (iii) PICC insertion and guided fluid prescription based on measurements of central venous pressure (CVP). A range of outcome measures were undertaken, plus two focus groups with ward staff and an interview with the research nurse to ascertain views concerning the implementation of the study. Descriptive findings identified that PICC use in this group of patients was extremely difficult. The practical issues affecting the feasibility of this study were: (i) the physical and psychological frailty of the patients, proxy consent, difficulties measuring outcomes, unsuccessful PICC placement due to aged veins, intolerance to lines; (ii) staff concerns relating to patient vulnerability, competent use of new technology, limited resources and work capacity. Most aspects of the trial were made more difficult due to the frailty of the patient group.