Peripheral intravenous catheters (PIVCs), improving post-insertion care and patient safety with a reliable assessment tool

Abstract

English summary Peripheral intravenous catheters (PIVCs), improving post-insertion care and patient safety with a reliable assessment tool Norwegian hospitals routinely administer one or more peripheral venous catheters (PIVCs) to most admitted patients. In 2021, 3.2 million PIVCs were inserted in Norway. While serious complications are rare, given the high volume of catheters being inserted, PIVCs constitute a significant risk factor for bloodstream infections, thrombophlebitis, subcutaneous infusions, leakage, air embolism, nerve damage, or blocked catheters leading to treatment failure. This thesis focuses on the use and care of PIVCs. In 2014, St. Olavs Hospital and Levanger Hospital participated in an international multicenter study led by the University of Western Sydney called the “One Million Global Catheters: PIVC Worldwide, Prevalence Study (OMG)”. Study I present our results from this participation, specifically, that there was significant room for improvement in PIVC care and follow-up. The incidence of unused PIVCs was 36.8%, while 71.0% lacked documentation, and 20.6% had soiled dressings. As a result of the substandard quality in PIVC care in the OMG study, we developed and validated a tool for quality control and improvement of PIVC practice, the PIVC mini-Questionnaire (PIVC-miniQ) (Study II). The PIVC-miniQ assists in identifying signs and symptoms that may be related to the development of a bloodstream infection, such as redness, pain, warmth at the injection site, and/or a red line along the vein. In addition, it measures risk factors such as lack of documentation, lack of indication, and soiled dressing. In total, the PIVC-miniQ maps 16 deviations from best practice with a total score from 0 to 16 deviations. When the tool was tested, the PIVC-miniQ‘s total score showed a moderate to high interrater score. It can be used in improvement work at a system level, both as a measurement of PIVC quality at the ward level but also for a prevalence survey of PIVC deviations at the hospital level. The PIVC-miniQ has also been validated for use in Nepal and is used both in Norway and in other countries. In Study III, we utilized quantitative and qualitative methods (i.e., mixed methods) to explore what prevents and promotes the use of evidence-based guidelines in different hospital wards. For the quantitative component, we used the PIVC-miniQ to investigate the quality of peripheral intravenous catheters in all wards at St. Olavs Hospital. For the qualitative component, we conducted interviews with 24 nurses from wards with either “very good” or “not so good” PIVC quality. We found that a bedside ward culture in which leaders and educational nurses have a focus on PIVC care was essential for PIVC quality. Conclusion: The results of the first study in this thesis are an important contribution to establishing the global incidence of PIVC challenges, through our active participation in an international multicenter study. This research has helped raise awareness about PIVC observation and management. The development of the PIVC-miniQ tool, which was the focus of the second study of this thesis, is another important contribution. This innovative tool is valuable for mapping PIVC quality, enabling its application in clinical audits, patient safety improvement initiatives, and research endeavors. The PIVC-miniQ has been proven to be feasible, with acceptable inter-rater reliability; this makes it an important instrument for healthcare professionals seeking to assess and enhance PIVC-related practices. The third study in this thesis was the first to apply a mixed methods approach in this area to explain variations in PIVC quality across different wards. Results provide an in-depth understanding of the underlying factors involved with PIVC challenges. Thus, the findings presented here represent a significant contribution to ongoing efforts aimed at improving patient outcomes, enhancing healthcare quality, and advancing patient safety related to intravenous catheterization.