The impact of flushing with pre-filled saline syringes on the incidence of peripheral venous catheter failure: A quasi-experimental study

Abstract

Background: Short peripheral venous catheters are one of the most frequently used devices in hospitals. Peripheral venous catheter failure, defined as the unscheduled dysfunction of peripheral venous catheter, is common and frequently entails a new invasive procedure. Flushing the catheter maintains patency and could prolong peripheral venous catheter dwell time. The introduction of pre-filled saline flushing syringes as compared to manually filled saline flushing syringes could facilitate the frequency of catheter flushing, and subsequently it could reduce peripheral venous catheter failure rate. Objective: To demonstrate differences in overall peripheral venous catheter failure rates before and after the introduction of pre-filled saline flushing syringes and to assess the risk factors for peripheral venous catheter failure. Methods: Quasi-experimental design, before-and-after intervention study. Intervention: introduction of pre-filled saline syringes for flushing. Multicenter study conducted in medical and surgical wards of three European hospitals during a 9-month period (4 months pre-intervention, 5 months intervention). A multivariate Cox proportional model was used to identify factors associated with the occurrence of peripheral venous catheter failure. Results: Data from 3853 peripheral venous catheters in 1915 patients were analyzed. Compared to pre-intervention period, a significant decrease in peripheral venous catheter failure rate was observed in the intervention period (57% vs 43.4%, p < 0.001). Independent factors associated with peripheral venous catheter failure were as follows: Charlson score ⩾4 (hazard ratio: 1.648; 95% confidence interval: 1.069–2.527), days of hospital stay ⩾10 (hazard ratio: 1.468; 95% confidence interval: 1.172–1.837), and catheter “D” (hazard ratio: 1.758; 95% confidence interval: 1.058–2.919). Conclusion: The use of pre-filled saline syringes significantly reduced peripheral venous catheter failure and increased catheter dwell time. Thus, it is important to reinforce the use of the pre-filled syringes for flushing to reduce the incidence of peripheral venous catheters’ failure.

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

“…unit of measurement, lack of core outcome definitions, heterogeneity). A recent pre-and post-test study observed a decrease in PIVC failure associated with the use of pre-filled syringes [28]. However, the overall failure rate even post-intervention remained high (43%) indicating that there are other drivers at play related to PIVC failure.…”

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

“…In two studies included in this review, the use of pre-filled syringes significantly reduced PVC failures and complication occurrence, increased the length of dwell of this device and reduced related costs (27,29) . It is pointed out that pre-filled syringes are marketed in order to minimize the incorrect choice of syringe size and solution to be used.…”

“…Regarding PVC, the volume and interval during flushing did not interfere in obstruction occurrence, on the other hand, the greater number of PVC manipulations throughout the day was a predictor of its failure (S1 (18) ); negligence or irregular performance of flushing generated an advanced stage of phlebitis in patients using PVC (S5 (22) ); flushing preparation with pre-filled syringes significantly reduced obstruction occurrence, with increased catheter dwell time and related costs reduction (S10 (27) ; S12 (29) ).…”

Nurses’ Involvement in the Development and Usability Assessment of an Innovative Peripheral Intravenous Catheterisation Pack: A Mix-Method Study

“…According to the study findings, nurses draw the required flushing volume from a 1000 mL bag of normal saline that is used throughout each shift. Manually prepared syringes are subjected to more manipulation during the filling procedure, putting them in closer touch with the healthcare staff and increasing the risk of catheter contamination [ 53 ]. Previous studies conducted in Portugal indicate that adherence to PIVC flushing is often overlooked by professionals due to a lack of recent training in vascular access, a lack of material for flushing, or user-unfriendly storerooms [ 54 , 55 ].…”