Infection Prevention and Control Service, Canterbury District Health Board, Christchurch, New Zealand.
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
J Clin Nurs. 2022 Aug;31(15-16):2324-2330. doi: 10.1111/jocn.16051. Epub 2021 Sep 17.
To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually).
Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy.
Observational point prevalence study.
Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used.
There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases.
Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC.
Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.
确定在一家三级护理大学医院（每年有大约 83000 名住院患者）的成年住院患者中外周静脉置管（PIVC）的流行率和政策依从性。
多达 80%的住院患者接受静脉治疗，最常见的是通过 PIVC。然而，这些设备并非没有风险。尽管有政策促进最佳实践，但研究表明，临床实践中 PIVC 管理标准不足。这导致过早失效，导致治疗延误、住院时间延长和潜在的静脉通路受损，从而影响后续的 IV 治疗。
观察性时点流行率研究。
在所有成人急性护理医学、外科和肿瘤病房进行研究。数据由在一天内配对工作的高级注册护士收集。使用描述性统计数据分析数据。使用 SQUIRE 2.0 清单进行质量改进报告。
调查日有 19 个病房的 449 名成年住院患者。197 名患者有一个或多个 PIVC 在位。在位的 PIVC 总数为 212 个。PIVC 流行率为 47%。52%的患者 PIVC 插入在弯曲部位，如肘窝、手背或手腕。只有 19%的病例记录了 8 小时视觉输液静脉炎（VIP）评分的评估。14.4%的病例患者出现局部静脉炎迹象。44%的病例患者不知道 PIVC 的原因/需要。
在临床实践中，发现证据为基础的指南与当地政策之间存在差异，包括在弯曲部位插入 PIVC 的高比率和记录不佳。这些质量问题增加了患者不良结局的可能性，尤其是当患者对其 PIVC 的原因缺乏认识时。
对最佳实践标准的不良依从性是“可以接受但不可接受的”。PIVC 失败对患者和医疗系统都是代价高昂的。需要重点关注改善 PIVC 护理和管理。
