Prof Joan Webster1,2, Ms Sarah Northfield1,3, Ms Emily Larsen1,2, Prof Claire Rickard1,2, Ms Nicole Marsh1,2, Prof Raymond Chan3
1Royal Brisbane and Women’s Hospital, Herston, Australia,
2Griffith University, Nathan, Australia,
3Queensland University of Technology, Kelvin Grove, Australia
Introduction: Many patients are discharged from hospital with their intravenous catheter still in place. Monitoring the site for clinical and research purposes is important but the extent to which a patient is able to reliably report the condition of their catheter insertion site is uncertain. The aim of the current study was to test the interrater reliability of a new instrument designed to test the level of agreement between nurses and patients when assessing an intravenous insertion site.
Methods: The study was a within-trial inter-rater reliability study of patients who were enrolled in a single-centre, randomised controlled trial. A 7-item instrument, containing questions about the condition of the dressing and the insertion site was developed. Assessment of the insertion site was conducted twice, once by the research nurse and, within a few minutes, independently by the patient. Proportions of agreement and Cohen’s kappa were calculated.
Results: Seventy three patients agreed to participate. The percentage agreement ranged from 70 to 100%. However, for the important clinical signs (redness, swelling, ooze, pus and tracking) there was a high level of agreement (97 – 100%). All of the kappa scores, apart from the ability to name the type of securement, fell into the category ‘substantial agreement’ (0.6-0.8) or almost perfect agreement (>0.8).
Conclusion: The clinical items on the PICC-SAT have substantial to almost perfect reliability making it a useful instrument to assess any undesirable signs and symptoms associated with a PICC insertion site.
Miss Emily Larsen is a Senior Research Assistant and Project Manager with the Alliance for Vascular Access Teaching and Research (AVATAR), responsible for co-ordinating a number of multi-site randomised controlled trials involving vascular access devices (both central and peripheral). Emily’s main interest is the surveillance and prevention of central line associated bloodstream infections, particularly within a cancer care service setting.