Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

Article


Keogh, Samantha, Shelverton, Caroline, Flynn, Julie, Mihala, Gabor, Mathew, Saira, Davies, Karen M., Marsh, Nicole and Rickard, Claire M.. 2020. "Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial." BMC Medical. 18 (1), pp. 1-11. https://doi.org/10.1186/s12916-020-01728-1
Article Title

Implementation and evaluation of short peripheral intravenous catheter flushing guidelines: a stepped wedge cluster randomised trial

ERA Journal ID40887
Article CategoryArticle
AuthorsKeogh, Samantha (Author), Shelverton, Caroline (Author), Flynn, Julie (Author), Mihala, Gabor (Author), Mathew, Saira (Author), Davies, Karen M. (Author), Marsh, Nicole (Author) and Rickard, Claire M. (Author)
Journal TitleBMC Medical
BMC Medicine
Journal Citation18 (1), pp. 1-11
Article Number252
Number of Pages11
Year2020
Place of PublicationUnited Kingdom
ISSN1741-7015
Digital Object Identifier (DOI)https://doi.org/10.1186/s12916-020-01728-1
Web Address (URL)https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01728-1
Abstract

Background: Peripheral intravenous catheters (PIVCs) are ubiquitous medical devices, crucial to providing essential fluids and drugs. However, post-insertion PIVC failure occurs frequently, likely due to inconsistent maintenance practice such as flushing. The aim of this implementation study was to evaluate the impact a multifaceted intervention centred on short PIVC maintenance had on patient outcomes. Methods: This single-centre, incomplete, stepped wedge, cluster randomised trial with an implementation period was undertaken at a quaternary hospital in Queensland, Australia. Eligible patients were from general medical and surgical wards, aged ≥ 18 years, and requiring a PIVC for > 24 h. Wards were the unit of randomisation and allocation was concealed until the time of crossover to the implementation phase. Patients, clinicians, and researchers were not masked but infections were adjudicated by a physician masked to allocation. Practice during the control period was standard care (variable practice with manually prepared flushes of 0.9% sodium chloride). The intervention group received education reinforcing practice guidelines (including administration with manufacturer-prepared pre-filled flush syringes). The primary outcome was all-cause PIVC failure (as a composite of occlusion, infiltration, dislodgement, phlebitis, and primary bloodstream or local infection). Analysis was by intention-to-treat. Results: Between July 2016 and February 2017, 619 patients from 9 clusters (wards) were enrolled (control n = 306, intervention n = 313), with 617 patients comprising the intention-to-treat population. PIVC failure was 91 (30%) in the control and 69 (22%) in the intervention group (risk difference-8%, 95% CI-14 to-1, p = 0.032). Total costs were lower in the intervention group. No serious adverse events related to study intervention occurred. Conclusions: This study demonstrated the effectiveness of post-insertion PIVC flushing according to recommended guidelines. Evidence-based education, surveillance and products for post-insertion PIVC management are vital to improve patient outcomes.

KeywordsCatheterization, Peripheral; Female; Guidelines as Topic; Humans; Male; Middle Aged
ANZSRC Field of Research 2020420506. Sub-acute care
420501. Acute care
420599. Nursing not elsewhere classified
Byline AffiliationsQueensland University of Technology
Griffith University
Department of Health, Queensland
Institution of OriginUniversity of Southern Queensland
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