Optimising peripheral venous catheter usage in the general inpatient ward: a prospective observational study.

AIMS AND OBJECTIVES

To evaluate current practices in managing peripheral venous catheters through catheter lifespan, reasons for removal and identifying potential predictors of catheter complications.

BACKGROUND

Peripheral venous catheter insertion is a common minimally invasive procedure performed during patient admission. Current routine replacement of catheters may not be required in the light of recent evidence.

DESIGN

A prospective observational study was carried out in April 2013.

METHODS

One hundred patients were selected by systematic sampling. Ward nurses with support from three research nurses collected data for two weeks, ceasing earlier if patient no longer required venous catheters, was discharged, passed on or was transferred to a nongeneral ward setting. Analysis for potential predictors was carried out using random-effects model.

RESULTS

A total of 218 catheters were sampled, with a median catheter lifespan of 2·0 days. Half the catheters were removed because of complications with only 13 catheter removals due to phlebitis (grade 1+) in the first three days. Percentage of catheters removed due to complications also decreased as indwelling time increased. Twenty-three catheters (8·3%) could also have been saved as they were rendered 'not required/discharge' on day 1. Only insertion on the outer forearm was found to be associated with the likelihood of developing venous catheter complications.

CONCLUSIONS

Phlebitis rates in our setting are comparable to other published studies with all phlebitis cases occurring before the third day. The median catheter lifespan of two days is shorter than routine three-day replacement, which warrants an urgent review of current insertion and maintenance practices in our local setting.

RELEVANCE TO CLINICAL PRACTICE

Changing practice from routine replacement to clinically indicated has benefits to nurses and patients in terms of manpower time and costs. However, an effort to maximise peripheral catheter lifespan is necessary through daily vigilant catheter care and regular audits of practices.