Dr Gillian Ray-Barruel1,2,3, Prof Marie Cooke1,4, Prof Marion Mitchell1,2,4, Dr Vineet Chopra5, Prof Claire Rickard1,2,3,4
1Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Australia
2Princess Alexandra Hospital, Brisbane, Australia
3Royal Brisbane and Women’s Hospital, Brisbane, Australia
4School of Nursing and Midwifery, Griffith University, Nathan, Australia
5Patient Safety Enhancement Program, Michigan Medicine and VA Health System, Ann Arbor, USA
Introduction: In Australia, audits reveal idle cannula rates are between 23% and 50%. Leaving peripheral intravenous cannulas (PIVC) in place when no longer needed poses a bloodstream infection risk. I-DECIDED is a mnemonic tool designed to prompt assessment and decision making, with a focus on removing redundant invasive devices. We aimed to determine if a structured assessment and decision tool (I-DECIDED) could improve timely removal of redundant PIVCs.
Methods: We conducted an interrupted time-series study with 16 time-points (8 pre, 8 post) over 11 months in 5 medical/surgical wards at two Brisbane hospitals. A redundant cannula was defined as a PIVC not used in the past 24 hours or unlikely to be used in the next 24 hours. PIVCs in unstable or telemetry patients were excluded. A vascular access device assessment form was implemented at the 4-month mark, with education sessions (including lanyard cards and posters) provided for 125 nursing staff. Fortnightly PIVC assessments and chart audits were undertaken. Seventeen focus groups (7 pre/10 post) were conducted with 78 nurses. Ethics committee approval was obtained. ANZCTR trial registration: ACTRN12617000067370p
Results: We screened 1727 patients, and 842 (49%) had a PIVC in situ. A total of 639 PIVCs were included in the final analysis. Redundant cannula rates reduced by 9.4% (26.5% pre, 17.1% post, p = 0.0039). Nurses in every focus group reported increased awareness of the need to remove PIVCs no longer in use.
Conclusion: Implementation of a structured assessment and decision tool can reduce the rate of idle PIVCs.
Dr Gillian Ray-Barruel is a leading nursing and ICU researcher who coordinated the OMG Study which recruited more than 40,000 patients with PIVCs globally. Dr Ray-Barruel is fully funded on a highly competitive Griffith University post-doctoral fellowship to improve assessment and action by bedside clinicians regarding prevention of PIVC complications.