Tricia Kleidon1, 2, Paula Cattanach1, Gabor Mihala3,4Amanda Ullman1, 2, 5, 6
1 Children’s Health Queensland, Lady Cilento Children’s Hospital, South Brisbane, Queensland, Australia
2 Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Australia
3 Centre for Applied Health Economics, Menzies Health Institute Queensland, Nathan Campus, Queensland, Australia
4 School of Medicine, Griffith University, Queensland, Australia
5 School of Nursing and Midwifery, Griffith University, Nathan Campus, Queensland, Australia
6 Paediatric Critical Care Research Group, Children’s Health Queensland, South Brisbane, Queensland, Australia
Introduction: Peripheral intravenous catheters (PIVCs) have previously taken a back seat to the more topical central venous access device (CVAD). PIVCs are however prevalent in paediatric healthcare and routinely cited as one of the most painful and anxiety producing inpatient experiences. The insertion and care of PIVCs are a complex interdisciplinary responsibility. PIVCs are associated with a high rate of failure and dysfunction.
The aim of this prospective pre-post intervention study was to improve PIVC outcomes and reduce failure and its unintended sequalae.
Method: This multi-faceted intervention included; staff surveys and patient/parent interview, audit of current practice, implementation of SUCCESS PIVCs (At insertion: Skills, Understand and prepare, Consent, Clean site, Escalate, Secure, Sign and document. During management: Prompt removal, Inspect hourly, Vein patency, Clean hands and Scrub the hub), was developed and implemented via visual aids, workshops and change champions.
Results: Pre-implementation audit (n=102) and survey (n=117) data described high rates of peripheral intravenous catheter failure (n= 50; 49%), difficulty obtaining equipment (n=64; 55%), and pressure to insert (n=50; 43%). Parent interviews (n=15) identified lack of communication, fear, appreciation of skilled technicians and technology, and caregiver roles, as key to improving the experience. Implementation of SUCCESS PIVCs was associated with improvements in first time insertion success (45% vs 62%; RR 1.37, 95% CI 1.05-1.78), first attempt escalation to senior clinicians (junior doctor 72% vs 41%; p=<0.001), and median peripheral intravenous catheter dwell (40 vs 52 hours; p=0.021).
Conclusion: This multilevel care bundle demonstrated improvements in insertion and management of peripheral intravenous catheter, however, PIVC failure remained high and further robust trials are required to reduce PIVC failure.