Peripheral IV catheter policy adherence
Abstract:
Aims and objectives: To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually).
Background: Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy.
Design: Observational point prevalence study.
Methods: Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used.
Results: There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases.
Conclusions: Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC.
Relevance to clinical practice: Poor adherence to best practice standards is ‘accepted but unacceptable’. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.
Reference:
Berger S, Winchester K, Principe RB, Culverwell E. Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital. J Clin Nurs. 2021 Sep 17. doi: 10.1111/jocn.16051. Epub ahead of print. PMID: 34535927.