Dr Josephine Lovegrove1,2,3,4, Mr. Jonathan Vico da Silva1,4,5, Professor Robert S Ware4,6, Professor Amanda Ullman1,4,7, Dr Peter Snelling4,5, Professor Nicole Marsh3,4,8, Professor Claire Rickard1,2,3,4
1NHMRC CRE in Wiser Wound Care, Griffith University, Southport, Australia, 2Herston Infectious Diseases Institute, Metro North Health, Herston, Australia, 3School of Nursing, Midwifery & Social Work, The University of Queensland & UQCCR, St Lucia, Australia, 4Alliance for Vascular Access Teaching and Research, Nathan, Australia, 5Gold Coast University Hospital, Gold Coast Health, Southport, Australia, 6School of Medicine & Dentistry, Griffith University, Nathan, Australia, 7Centre for Children’s Health Research, Children’s Health Queensland Hospital & Health Service & Faculty of Medicine, The University of Queensland, Brisbane, Australia, 8Royal Brisbane & Women's Hospital, Metro North Health, Herston, Australia
Biography:
Dr Josephine (Josie) Lovegrove is an experienced registered nurse with a background in aged care and acute (surgical) nursing, who moved into research with an interest in health care quality and patient safety. As a Senior Research Fellow with the NHMRC CRE in Wiser Wound Care, Josie's research is predominately concentrated within the areas of intravascular devices and surgical wounds. Josie also has a track record of work focused on pressure injury prevention. Overall, Josie has disseminated her work and has contributed to the supervision of Bachelor of Nursing (Honours) and Doctor of Philosophy students (completed and ongoing).
Abstract:
Introduction
Peripheral intravenous catheters (PIVCs) should be removed when no longer needed, with guidelines recommending either removal and replacement routinely at 72 hours (adults only) or as clinically indicated (adults/paediatrics). This study described and explored reasons for PIVC removal, or lack thereof, in practice.
Methods
A secondary analysis of a stepped-wedge cluster trial was conducted. Participants with a successfully inserted PIVC were included from three tertiary hospitals and 12 wards (general and specialty medical/surgical, emergency/trauma, oncology/haematology, coronary care, intensive care). Adult and paediatric analyses were performed with logistic regression (binary/multinomial) to identify associations between PIVC removal and patient/PIVC characteristics.
Results
PIVCs (adult n=1137/paediatric n=701) were removed as treatment complete without (62.0%/55.8%) or with complications (4.6%/14.6%), treatment incomplete with complications (20.0%/27.2%), or for routine resite (9.0%/0.9%). Some dwelled 73-82 hours (8.4%/12.6%) and >92 hours (17.8%/25.1%). Daily checks during dwell identified ≥1 complication in 19.6% adult and 21.7% paediatric PIVCs, but over 50% of these remained in-situ for >24-hours. Over 20% of PIVCs were left idle, with idle-associated factors including PIVC insertion-site location, and for adults only, specialty. Factors associated with reasons for removal (treatment in/complete with/out complications, routine resite) in both cohorts were specialty, difficult intravenous access, insertion-site location and idle status, and for adults only, insertion complications and dwell-time.
Conclusion
The results suggest most PIVCs are removed based on clinical indication. However, many are left in place with a complication or when no longer needed. Education and surveillance of PIVC care processes, including removal, should support optimal practices.