The Implementation of a Standardized Peripheral Intravenous Securement and Maintenance Guideline for Nurses in Pediatric Ward

By LAM Yi Lei, Elisa, RN, BN, MNurs, PRCC (Pediatric Intensive Care Nursing), Ward 26/F, Pediatric Ward

Background

Up to 11% of peripheral IV lines in the pediatric population are infiltrated causing problems with tissue necrosis, scarring, nerve damage or amputation. Primary prevention of peripheral IV complications in the early stage is extremely important and it is important to take necessary actions to preserve catheter survival rates. Skin damage and mechanical phlebitis are related to peripheral IV securement or excessive movement of catheter in the blood vessel.  Excessive IV securement obscures site assessment, prevents early detection of complications, and requires significant nursing time. Securing IVs properly may decrease the risk of complications. Dressings are recommended to be transparent and semi-permeable.

Purpose and Problem Statement

The purposes are aimed on defining the problems with current peripheral IV securement/dressing in pediatric patients, identifying the factors associated with improper IV securement, signs and symptoms of IV complications, discussing guidelines for pediatric patients’ peripheral IV securement and maintenance.

 Current practice of peripheral IV securement in pediatric ward:
•         Insertion site is not visible for proper assessment.
•         IV site is excessively tape IV site is obscured and nurses are unable to detect early sign of IV complications.
•         Guideline of peripheral IV maintenance mainly for adults

Implementation Plan

The implementation plan is to have presentation to ward nurses to emphasis the importance of a visible IV site. New peripheral IV dressing material is encouraged to use. It is necessary to revise guideline of peripheral IV securement and maintenance for pediatric patients. Nurses’ knowledge of IV site assessment will be evaluated with pre & post test. Poster is hanged for reference of IV dressing and the Touch-Look-Compare method of IV assessment on the ward. Copy of presentation contents will be given to the nurses for references.

Results

About 25% increase in knowledge of peripheral IV device assessment and maintenance. There were 67% IV complications events detected without severe harm. After implementation there was no significant decrease in the peripheral IV failure rate, however, senior and junior nurses were able to remove the IV catheter immediately if an IV site was at risk.

Recommendations and Next Steps

Some limitations regarding peripheral IV securement recommendations need further exploration

Challenges identified in relation to the limitations of this project included:
•         Implementation of peripheral IV education to a number of staff within a short period (1 month) and may be associated with poor knowledge retention over time.
•         Although all nursing staff received education on the Touch-Look-Compare method, no data was collected on the accuracy of nursing staff in performing this check.

In the future, this project is suggested to promote strategies of standardized peripheral IV education of patients and caregivers on admission. Education includes expectations for every-60-minutes IV site assessments and orientation of TLC posters in patient rooms. It is also suggested to expand the strategies of standardized peripheral IV securement and maintenance guideline to nursery units in the maternity department.