Preventive risk analysis in the maintenance of patency of the peripherally inserted central catheter

Abstract

This theoretical and reflexive study analyzed the risks related to the maintenance of patency of the Peripherally Inserted Central Catheter with the use of saline solution in comparison with saline-filled syringes, through the application of the Healthcare Failure Mode and Effect Analysis - HFMEA. The process was mapped, detailing the failure modes of each step. For the calculation of the Risk Priority Number, the severity and probability of the failure modes were analyzed. This analysis gave rise to the severity and probability matrix. Finally, actions to reduce the failure modes in the maintenance of patency were proposed, considering the use of saline-filled syringes in comparison to the use of saline ampoules. It was verified that the use of saline ampoules is associated with a greater risk, since it requires four stages more than saline-filled syringe does not, increasing the risk of contamination and the level of three different risks, which would result in additional hospital costs. The use of the saline-filled syringe would avoid risks that could negatively affect the patient’s health, the nursing professional and the health institution.

Flushing in Intravenous Catheters

“…35 However, despite the existence of saline-filled syringes on the market, the maintenance of venous catheter patency is still performed in many institutions in Brazil with saline solution ampoules, requiring the use of needles for aspiration, syringes, and ampoules of the solution, like the institution where one study was carried out. 36 In the observations, most participants used syringes with a volume of 10 mL for the CVADs and PIVCs to administer 1 or 2 drugs. The use of 5-mL syringes ranged from 3% to 10% in CVADs and 11% to 17% in PIVCs; 5-mL syringes generate a pressure of 90 PSI and can damage the catheter.…”

What do we know about flushing for intravenous catheter maintenance in hospitalized adults?

“…The procedure for maintaining catheter patency is a care responsibility of the nursing team, for which it is necessary to have knowledge and competence, requirements that allow it to prevent failures, notify errors and promote the safety and wellbeing of patients who use medications intravenously (6) . National and international studies show results indicating a variability in the practice of flushing, pointing out difficulties of nursing professionals in its implementation (7)(8)(9)(10)(11)(12) .…”

“…Regarding the way to prepare for flushing, studies show that syringes pre-filled with normal solution are associated with an increase in catheter permanence time, reduction in the time needed to prepare for flushing and the risk of contamination of the device or solution, maintenance positive pressure during lavage, in addition to the potential to help promote adherence to clinical protocols and guidelines for flushing (9)(10) . However, in many institutions, the solution to perform flushing still requires prior preparation, involving the consumption of aspiration needle, syringes and solution ampoules (11) .…”

“…Given the high degree of variation in the practice of maintaining permeability of peripheral and central venous devices observed in research on the subject in question (1,3,(7)(8)(9)(10)(11)(12) , which indicate the need for more evidence on volume, technique and regime to be applied as well as on the effects of flushing in complications prevention; this proposal for a review is justified, in order to contribute with knowledge that sustains professional practice.…”

Occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy

“…Anticancer treatments are complex and involve the use of three basic modalities: surgery, chemotherapy, and radiotherapy. In general, they are long and aggressive, and often need secure access to the venous network to administer, for example, chemotherapeutics (3).…”