Director of Missouri Region - Vascular Access Specialist Midwest Nursing and Vascular Services, LLC Eureka, Missouri
Purpose: : Hospitalized adult patients often require more than 1 short peripheral catheter (SPC) to complete the IV therapy due to catheter failure and the routine replacement. The purpose of this project was to increase the number of SPCs dwelling for the entire duration of the IV therapy using a bundled approach.
Methods: : Implementation of an engineered securement device (ESD), education pertaining to modifiable risk factors, and changing the practice to removal upon clinical indication were methods used to reduce the number of SPC insertions and catheter failures. This study was conducted at a rural, Midwestern hospital using a convenience sample (N=405) and an observational, descriptive, cohort design in 6 phases between September 2019 and March 2020.
Results: : Following the practice changes, there was a reduction of SPC replacement (24%), catheter failures (24% to 13%), SPCs per patient (M=2.9 to 2.2; P = .045), SPC insertions (4,000 per year), and SPC catheter-related bloodstream infections (CR-BSIs) (0.26 per 1000 catheter days to 0.0) and a significant increase of SPCs remaining in situ (M=2.6 to 3.8 days; P = <.001) resulting in an estimated cost savings of at least $285,000. The results demonstrated the risk of failure significantly increased when SPCs were inserted in the wrist (P = .007) and upper arm (P = .026) and significantly reduced when inserted in the forearm (P = 0.39).
Limitations:: A limitation of this project was the potential overlapping of interventions during phases of the analysis.
Conclusions: : Study findings suggest using an ESD, promoting SPC insertion in the forearm, avoiding the wrist and upper arm, and changing practice to removal when clinically indicated reduced the number of SPC insertions and rate of catheter failures.
