Routine Versus Clinically Indicated Rotation of Peripheral - PDF document

1 Routine Versus Clinically Indicated Rota
Routine Versus Clinically Indicated Rotation of Peripheral Intravenous Access Based on Comfort, Cost, and Complications Jovie P. Velasco, BSN, RN, CCRN; Jenifer Beaty, BSN, RN; Lori Ann Engelke, RN, CRNI; Mona Guilfoil, RN, CRNI, OCN; Barbara Ma jo r, RN, PCCN; Tanja Gross, BSN, RN, PCCN; Heidi Chroszielewski, MSN, RN, PCCN; Susan Ahmed, RN; Patty Hengel, BSN, RN; Gladys Sesbreno, BS N, RN; Erundina Krenzischek, PhD, RN, CPAN, FAAN Mercy Medical Center, Baltimore, Maryland  Replacing short peripheral intravenous access in adults only when clinically indicated is an unresolved issue .  Mercy Medical Center’s nursing policy requires a short peripheral IV site be rotated every 72 hours in adult hospitalized patients .  According to the CDC, a short peripheral IV does not require rotation any more frequently than 72 - 96 hours .  The Infusion Nurses’ Society (INS) Standard of Practice recommends rotation only if clinically indicated .  Nursing task time can range from 5 - 20 minutes per IV start .  Cost analysis of each IV start = $ 10 . 18 Among adult inpatients, how long can an asymptomatic peripheral intravenous access remain in place prior to site rotation? Background PICO Question Search Strategy/Evidence Appraisal  CINHAL and PubMed were used to search for articles related to routine and clinically indicated rotation of peripheral intravenous access . A total of 31 articles were collected, 29 of these were accepted and appraised . Evidence Summary Centers for Disease Control. (2011). Guidelines for the Prevention of Intravascular Catheter - Related Infections, 2011. Retrieved from http://www.cdc.gov/hicpac/pdf/guidelines/bsi - guidelines - 2011.pdf Ho, K. H., & Cheung, D. S. (2012). Guidelines on timing in replacing peripheral intravenous catheters. Journal Of Clinical Nursing , 21 (11/12), 1499 - 1506 8p. doi:10.1111/j.1365 - 2702.2011.03974.x Infusion Nursing Society. (2012). Recommendations for Frequency of Assessment of the Short Peripheral Catheter Site. Retrieved from http://www.ins1.org/files/public/07_05_12_Assessment_Position_Paper_BOD_FINAL.pdf Rickard, C. M., McCann, D., Munnings , J., & McGrail , M. R. (2010). Routine re - site of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated re - site: a randomized controlled trial. BMC Medicine , 8 53. doi:10.1186/1741 - 7015 - 8 - 53 Webster, J. (2015). Clinically - indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Of Systematic Reviews , (8), doi:10.1002/14651858.CD007798.pub4 Wu, M. A., Casella, F. (2013). Is clinically - indicated replacement of peripheral catheters as safe as routine replacement in preventing phlebitis and other complications. Internal and Emergency Medicine, 8(5), 443 - 444.  The evidence revealed that there is no difference in the complication rate between routine and clinically indicated rotation . A clinically indicated rotation is safe and equivalent to a routine replacement in terms of development of phlebitis . Frequent re - sites are distressing for patients, have a significant cost component, add to nursing task time, and may lead to future venous access difficulties .  To reduce the risk of peripheral IV catheter - related infections, place the IV catheter in upper extremities, use 2 % alcoholic chlorhexidine for skin disinfection before insertion, and use intermittent flushing to maintain patency .  For all patients who have a locked peripheral IV catheter for intermittent infusions, the site should be assessed with every catheter access/infusion or at a minimum of twice per day . When an infusion is running, it should be routinely assessed for redness, tenderness, swelling, drainage, and/or presence of paresthesias, numbness, or tingling, at least every 4 hours .  Infected catheters should be removed as soon as possible to prevent them from becoming a source of bloodstream infection .  All short peripheral intravenous site dressings must be changed every 5 - 7 days, and more often as indicated .  The continued need for the IV site should be examined daily, and catheters should be removed if no IV therapy is planned .  Assessment of the site, early detection of infection, and removal of the catheter are crucial in reducing infection . References Translation Pilot Study Results Pre - Implementation Post - Implementation 25 Patients/33 IVs (11 IVs excluded) 22 IV sites left in place ≤ 3 days No S/S of Phlebitis! 22 Patients/31 IVs (9 IVs excluded) 22 IV sites left in place ≥ 3 days No S/S of Phlebitis! Practice Change is Feasible!  Pilot study completed utilizing recommended practice changes, and feasibility was established.  Based on the evaluation of post translation, the electronic nursing peripheral IV documentation was re - designed to facilitate assessment, implementation, and evaluation.  Guideline created entitled “Rotation and Assessment of Short Peripheral Intravenous Access in Adult Patients.”  Guideline approved by the Nursing Professional Practice Council and currently awaiting final leadership approval prior to education and implementation house - wide. Recommendation  Based on the results of the literature analysis and pilot study outcomes, the recommendation was made to re - site short peripheral IV access only when there is a clinical indication. Additionally, implementing clinically - indicated rotation of peripheral intravenous access can decrease hospital costs and nursing task time, and improve patient satisfaction.