"With a PICC line, you never miss": The role of peripherally inserted central catheters in hospital care for people living with HIV/HCV who use drugs
"With a PICC line, you never miss": The role of peripherally inserted central catheters in hospital care for people living with HIV/HCV who use drugs
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DOI：
10.1016/j.drugpo.2021.103438
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发表时间：
2021-10-30
影响因子：
4.4
通讯作者：
Carusone, Soo Chan
中科院分区：
文献类型：
--
作者：
Guta, Adrian;Perri, Melissa;Carusone, Soo Chan
背景：吸毒者（PWUD），尤其是注射毒品者，获得血源性感染的风险增加（例如，HIV和HCV），经历与药物相关的伤害（例如，药物过量和药物过量），以及住院治疗和需要通过外周插入中心静脉导管（PICC）输送的住院肠外抗生素治疗。PICC管路与PWUD的使用被认为是医院环境中紧张的一个来源，但尚未得到充分研究。从“新唯物主义”的理论和分析的见解，我们认为，通知使用PICCs.Methods的sociomaterial元素的集合：本文借鉴了N = 50的采访进行了两个相关的定性研究项目内的一个程序的药物使用的影响，从医疗保健提供者（HCP）和艾滋病毒/丙型肝炎病毒感染者使用药物的角度住院的研究。本文重点介绍了在这两项研究中收集的有关PICC线的数据。结果：提供、维护或移除PICC的决策是基于一系列复杂的因素（例如，感染、身体、药物、记忆、关系、空间、暂时性和偶然性），超出了胃肠外静脉内抗生素治疗是否有临床指征。HCP对过去、当前和未来的药物使用以及与非临床空间（例如，患者的家庭和周围社区），一些人选择二线治疗和去除PICC。大多数PWUD描述了在过去的住院期间，尽管病得太重而无法使用PICC导管，但仍受到出院和加强监测的威胁。一部分PWUD报告称使用PICC管路注射药物是一种减少伤害的策略，一部分HCP报告称提供了以减少伤害为中心的护理。我们的分析对理论化PICC管路在PWUD护理中的作用具有影响，并确定了实际指导，以使他们参与关于注入PICC管路的风险，如何安全地进行，以及医学支持的替代方案。
Background: People who use drugs (PWUD), and especially those who inject drugs, are at increased risk of acquiring bloodborne infections (e.g., HIV and HCV), experiencing drug-related harms (e.g., abscesses and overdose), and being hospitalized and requiring inpatient parenteral antibiotic therapy delivered through a peripherally inserted central catheter (PICC). The use of PICC lines with PWUD is understood to be a source of tension in hospital settings but has not been well researched. Drawing on theoretical and analytic insights from "new materialism," we consider the assemblage of sociomaterial elements that inform the use of PICCs.Methods: This paper draws on n = 50 interviews conducted across two related qualitative research projects within a program of research about the impact of substance use on hospital admissions from the perspective of healthcare providers (HCPs) and people living with HIV/HCV who use drugs. This paper focuses on data about PICC lines collected in both studies.Results: The decision to provide, maintain, or remove a PICC is based on a complex assemblage of factors (e.g., infections, bodies, drugs, memories, relations, spaces, temporalities, and contingencies) beyond whether parenteral intravenous antibiotic therapy is clinically indicated. HCPs expressed concerns about the risk posed by past, current, and future drug use, and contact with non-clinical spaces (e.g., patient's homes and the surrounding community), with some opting for second-line treatments and removing PICCs. The majority of PWUD described being subjected to threats of discharge and increased monitoring despite being too ill to use their PICC lines during past hospital admissions. A subset of PWUD reported using their PICC lines to inject drugs as a harm reduction strategy, and a subset of HCPs reported providing harm reduction-centred care.Conclusion: Our analysis has implications for theorizing the role of PICC lines in the care of PWUD and identifies practical guidance for engaging them in productive and non-judgemental discussions about the risks of injecting into a PICC line, how to do it safely, and about medically supported alternatives.