Every patient needs a drip, do they really?

(This post is authored by the creator ALLJanuary CE feature, “Evidence-based practice in peripheral intravenous catheter management“)

Questioning the established order.

As a former critical care nurse and current vascular access nurse researcher, I actually have been fortunate to travel and work with nurses from everywhere in the world on many projects. Part of my role as a researcher is to query the clinical practices we regularly take without any consideration and ask, “Is this the best way? Could there be a better way?” Research often begins by identifying practice, which isn’t at all times evidence-based.

Before the Covid-19 pandemic, I did a two-month internship within the US and visited several hospitals, where now and again I noticed that the majority inpatients had a peripheral intravenous catheter (PIVC) in place, but a lot of them didn’t have an intravenous catheter in place. in use. When I asked nursing and medical staff why patients had a PIVC tube they weren’t using, I used to be repeatedly told, “Every patient needs an IV, just in case.” When I identified that some patients had two or three PIVCs or also a central venous access device unused, it became obvious that this was a standard problem.

An “unused” catheter is a PIVC catheter that has not been used up to now 24 hours and has no plans to be used in the subsequent 24 hours. After surgery, the PIVC will be left in place until someone remembers to remove it. Shockingly, as much as 1 / 4 of PIVC is inserted but never used. It’s time to challenge PIVC “just in case”.

Staff time and convenience.

Having a PIVC in situ can provide a way of control and confidence that in an emergency situation, the patient may have easy intravenous (IV) access. If the patient’s condition is medically unstable or requires short-term intravenous therapy, it will be important to have a patented PIVC.

However, a stable patient will almost never require emergency access, and appropriate vascular access will be established if vital. A PIVC that has already been in place for a day or so without use may now not function effectively if you attempt to access it, requiring a brand new PIVC to be inserted and fewer veins to access. This means two or more attempts to insert the drip, which wastes staff time and hospital resources, and is painful for the patient.

Risk of blood infection.

Bloodstream infection is frequently regarded as attributable to more invasive central vascular access devices. If you think that PIVCs are a benign device and infrequently result in bloodstream infections, I encourage you to reconsider. The incidence of PIVC-related bloodstream infections is usually unknown and infrequently quantified. However, there may be growing evidence that PIVCs pose the identical risks as central devices, which is sensible. After all, any vascular access device is a portal leading directly into the bloodstream. Moreover, PIVCs are sometimes treated with less care than central devices. My team conducted a worldwide audit of the prevalence of PIVC dressings and located that one in five PIVC dressings are soiled or loose, which is a warning sign of potential infection.

Ship health and protection.

Nurses are increasingly specializing in vascular health and protection. And rightly so. Veins are a limited resource, from infancy to old age. Many patients require multiple attempts at insertion to acquire functional vascular access, and every attempt at insertion may lead to bruising and lack of the vein. If a PIVC is inserted and never used, it wastes viable veins that could be needed for urgent care later. Nurses needs to be patient advocates and speak up when routine intravenous cannulation isn’t within the patient’s best interest.

Slightly critical pondering goes a great distance.

PIVC shouldn’t be the default option for each patient. A nurse can support a patient’s vascular health in some ways. Here are some suggestions:

• Think twice before inserting an IV drip.
• In patients with difficult intravenous access, ultrasound guidance needs to be used.
• Consult your pharmacist to stagger IV drug administration in order that one drip is sufficient, even when medications are incompatible, or to discover alternative drug administration options.
• And ask yourself day-after-day if PIVC can work out. Consideration needs to be given as to whether the patient can address oral medications and fluids. Conduct some local audits and see what number of patients in your department have a PIVC that has not been used recently.
• Follow patients who’ve had a PIVC implanted to observe for infections or other complications.
• If hospital policy insists that a PIVC be placed in every patient, no matter indication, this needs to be questioned.

“Just in case” isn’t enough. Let’s attempt to do higher.

PhD, RN, MACN, is a senior research fellow on the Herston Institute of Infectious Diseases and the School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia; Adjunct Senior Research Fellow, School of Nursing and Midwifery, Griffith University; Director of Education for the Alliance for Vascular Access Teaching and Research (AVATAR); and associate editor of the journal Infection, Disease and Health.