Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

Abstract

Background Peripheral intravenous catheters (PIVCs) are ubiquitous medical devices, crucial to providing essential fluids and drugs. However, post-insertion PIVC failure occurs frequently, likely due to inconsistent maintenance practice such as flushing. The aim of this implementation study was to evaluate the impact a multifaceted intervention centred on short PIVC maintenance had on patient outcomes. Methods This single-centre, incomplete, stepped wedge, cluster randomised trial with an implementation period was undertaken at a quaternary hospital in Queensland, Australia. Eligible patients were from general medical and surgical wards, aged ≥ 18 years, and requiring a PIVC for > 24 h. Wards were the unit of randomisation and allocation was concealed until the time of crossover to the implementation phase. Patients, clinicians, and researchers were not masked but infections were adjudicated by a physician masked to allocation. Practice during the control period was standard care (variable practice with manually prepared flushes of 0.9% sodium chloride). The intervention group received education reinforcing practice guidelines (including administration with manufacturer-prepared pre-filled flush syringes). The primary outcome was all-cause PIVC failure (as a composite of occlusion, infiltration, dislodgement, phlebitis, and primary bloodstream or local infection). Analysis was by intention-to-treat. Results Between July 2016 and February 2017, 619 patients from 9 clusters (wards) were enrolled (control n = 306, intervention n = 313), with 617 patients comprising the intention-to-treat population. PIVC failure was 91 (30%) in the control and 69 (22%) in the intervention group (risk difference − 8%, 95% CI − 14 to − 1, p = 0.032). Total costs were lower in the intervention group. No serious adverse events related to study intervention occurred. Conclusions This study demonstrated the effectiveness of post-insertion PIVC flushing according to recommended guidelines. Evidence-based education, surveillance and products for post-insertion PIVC management are vital to improve patient outcomes. Trial registration Trial submitted for registration on 25 January 2016. Approved and retrospectively registered on 4 August 2016. Ref: ACTRN12616001035415.

Multimodal intervention for preventing peripheral intravenous catheter failure in adults (PREBACP): a multicentre, cluster-randomised, controlled trial

“…We identified some independent factors protecting patients from PIVC failure, including insertion in the forearm with 20 -22 gauge, visual inspection of insertion site, maintenance of transparent polyurethane PIVC dressing and optimal PIVC flushing, all in agreement with published reports 7,23,26,27 . In our study, the overall mean of dressing status was substantially higher for the intervention group compared to the control group at 12 months (66•86 [SD 17 •10] vs 51•37 [SD 25 •26]), a rate comparable to the 64 -79% of dressings in optimal conditions reported previously 13,23,28 .…”

“…To date, many studies using multimodal interventions have successfully reduced PIVC failure and complication rates, and the incidence of peripheral intravenous catheterrelated to bloodstream infections [6][7][8] . However, the results from these studies must be interpreted with caution due to, for example, their use of unrandomized or non-equivalent groups, or the conduct on single sites, which would limit the generalisability of the results.…”

Difficult Intravenous Access and Its Management

“…Therefore, it is crucial for healthcare professionals to be aware of the factors that may lead to this condition, including several negativities, to understand how to manage it [7,8]. The guidelines available for peripheral intravenous insertion mainly focus on site selection and insertion, and there is a lack of established guidelines on how to recognize or manage DIVA [1,[9][10][11]. In this context, the present study was aimed to provide basic information regarding the risk factors for difficult peripheral intravenous cannulation and its management.…”

Current practices of peripheral intravenous catheter fixation in pediatric patients and factors influencing pediatric nurses’ knowledge, attitude and practice concerning peripheral intravenous catheter fixation: a cross-sectional study

“…Peripheral intravenous catheters (PIVCs) are the most widely used intravenous treatment tools for hospitalized patients [1,2]. Previous studies have shown that PIVCs are administered to approximately 80% of inpatients for fluid supplementation, medication, blood transfusion, etc.…”

“…The PIVC fixation method normally proceeds as follows: (1) the PIVC and infusion tube are secured with tension-free dressing; (2) the dressing should be shaped based on the shape of the Y joint of the PIVC; (3) the dressing is pressed from the center to the edge; then, (4) using tape, and without applying too much pressure, the root of the extension line is fixed in an omega (Ω) shape.…”