Insertion site assessment of peripherally inserted central catheters: Inter-observer agreement between nurses and inpatients

Introduction Many patients are discharged from hospital with a peripherally inserted central catheter (PICC) in place. Monitoring the PICC insertion site for clinical and research purposes is important for identifying complications, but the extent to which patients can reliably report the condition of their catheter insertion site is uncertain. The aim of this study was to assess the inter-observer agreement between nurses and patients when assessing a PICC site. Methods The study was based on inpatients who were enrolled in a single-centre, randomised controlled trial comparing four different dressing and securement devices for PICC sites. A 7-item PICC Site Assessment Tool (PICC-SAT), containing questions about the condition of the dressing and the insertion site was developed. Assessment was conducted 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. Overall, percentage agreement ranged from 83 to 100% (kappa .65 to .82). For important clinical signs (redness, swelling, ooze, pus and tracking), there were high levels of percentage agreement (98 - 100%). Conclusion The high level of agreement between nurse/patient pairs make the instrument useful for assessing PICC-associated signs of localised infection, allergic or irritant dermatitis, or dressing dislodgement in a community setting.