Care of Peripheral Intravenous Catheters in Three Hospitals in Spain: Mapping Clinical Outcomes and Implementation of Clinical Practice Guidelines

Abstract

Background: Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures. Aim: To analyse the clinical outcomes from clinical practice guideline recommendations for PIVC care on different hospital types and environments. Methods: We conducted an observational study in three hospitals in Spain from December 2017 to April 2018. The adherence to recommendations was monitored via visual inspection in situ evaluations of all PIVCs inserted in adults admitted. Context and clinical characteristics were collected by an evaluation tool, analysing data descriptively. Results: 646 PIVCs inserted in 624 patients were monitored, which only 52.7% knew about their PIVC. Regarding PIVC insertion, 3.4% (22/646) patients had at least 2 PIVCs simultaneously. The majority of PIVCs were 20G (319/646; 49.4%) and were secured with transparent polyurethane dressing (605/646; 93.7%). Most PIVCs (357/646; 55.3%) had a free insertion site during the visual inspection at first sight. We identified 342/646 (53%) transparent dressings in optimal conditions (clean, dry, and intact dressing). PIVC dressings in medical wards were much more likely to be in intact conditions than those in surgical wards (234/399, 58.7% vs. 108/247, 43.7%). We identified 55/646 (8.5%) PIVCs without infusion in the last 24 hours and 58/646 (9.0%) PIVCs without infusion for more than 24 hours. Regarding PIVC failure, 74 (11.5%) adverse events were identified, all of them reflecting clinical manifestation of phlebitis. Conclusions: Our findings indicate that the clinical outcome indicators from CPG for PIVC care were moderate, highlighting differences between hospital environments and types. Also, we observed that nearly 50% of patients did not know what a PIVC is.

What Fuels Suboptimal Care of Peripheral Intravenous Catheter-Related Infections in Hospitals? – A Qualitative Study of Decision-Making Among Spanish Nurses

“…The consequences of such lack of engagement are not surprising, as seen in other studies reported by our group where we identified that ~50% of patients did not know anything about the catheter they carried [19]. These findings are concerning in themselves, but also highlight the missed opportunities to embed patient education about multiple related safety areas such as .…”

“…However, participants acknowledged that they did not engage in patient education, arguably the initial requirement for patient implication in care. The consequences of such lack of engagement are not surprising, as seen in other studies reported by our group where we identified that ∼50% of patients did not know anything about the catheter they carried [19]. These findings are concerning in themselves, but also highlight the missed opportunities to embed patient education about multiple related safety areas such as infection prevention and control, hand hygiene, and vascular catheter care, where patients could have a crucial role [34].…”

“…However, these studies did not provide insights into any institutional mechanisms likely in place to assure patient safety and quality in PIVC care [14]. The determinants of optimal catheter use can exert an influence at different levels: individual (i.e., often reported gaps in knowledge and skills among nurses [15]), social (i.e., collective perceptions shaping the relative importance apportioned to PIVCs and, by extension, their adverse events [16]) and, finally, organisational (i.e., unclear guidelines [17] or as our group has reported, lack of patient involvement in their self-care [18,19]).…”

“…However, implementing and adopting recommendations within CPGs can be protracted [21] due to clinician perceptions [22], the volume and quality of the evidence [23], and even difficulties to integrate the mandates of different CPGs [17]. Specifically, previous findings from our group suggest that the decision-making of nurses was suboptimal regarding the adoption of CPG recommendations for preventing infectious complications and failure related to PIVC, highlighting behavioural and organisational differences between hospital environments and services [19]. Further exploring individual motivations, barriers and facilitators within organisations would contribute towards understanding the contextual elements that underpin decision-making around PIVC care [24,25].…”