Academic journal article Australian Health Review

Intravascular Device Use,management, Documentation and Complications: A Point Prevalence Survey

Academic journal article Australian Health Review

Intravascular Device Use,management, Documentation and Complications: A Point Prevalence Survey

Article excerpt

Introduction

Intravascular devices (IVDs) are required by patients for the administration of fluids and or drugs while in hospital. Devices such as central venous catheters (CVCs), peripherally inserted central catheters (PICCs) and peripheral venous catheters (PVCs) all pose potentially serious infection risks to hospitalised patients. Although CVCs and PICCs pose a greater infection risk,1 the insertion of aPVCis the most common invasive medical procedure1,2 with between 30% and 80% of people admitted to hospital receiving aPVCduring their stay.3 Thus, PVCs are also a significant risk factor in acquiring a health care-associated infection (HAI).4-7 It is estimated that bloodstream infections occur in ~5.3 per 1000 catheter days for central venous access devices8 and for 0.1% of PVC or 0.5 per 1000 catheter days,2 which may seem insignificant but it contributes to the economic burden of HAI, which is estimated to potentially cost A$1 billion per annum in Australia.9

PVC-related complications are often associated with insertion technique or reactions to the catheter or infusate. However, other key risk factors have been identified, including delayed removal of the device when no longer in use and the administration of medications like potassium chloride and some antibiotics.3 Point prevalence surveys undertaken in New Zealand and theUK identified several additional areas for improvement, chiefly documentation on dating when the device was inserted, purpose of the PVC and assessment of the site.10-12

Using surveillance surveys to identify clinical practice issues and providing feedback is an effective method for reducing HAI.3,5,11,13 For example, improvements were seen by Goddard et al.10 over the 12-month period in which they conducted monthly prevalence surveys and provided feedback to staff.

In September 2011, Australian health ministers endorsed the National Safety and Quality Health Service Standards.14 Following a grace introduction period, implementation of the 10 standards, including Standard 3, 'preventing and controlling healthcare associated infections', became mandatory for all public and private hospitals from 1 January 2013. In response, the Royal Brisbane and Women's Hospital Executive Director of Nursing Services formed four nursing research councils to address clinical practice areas that fall under the standards. The Intravenous Access Research Council identified clinical practice and management of IVDs as a clinical area in which the quality of patient care and patient outcomes could be potentially improved.

As an initial step, a point prevalence survey was undertaken to examine the use, management, documentation and complications for IVDs in cardiac, medical and surgical inpatients.

Methods

Design

The survey was undertaken at a large tertiary teaching hospital in Brisbane, Queensland. Inpatients who could be approached were verbally invited to participate in the study and verbal consent was obtained at the time of data collection. The study was approved by the Human Research and Ethics Committee at the Royal Brisbane and Women's Hospital (reference no. HREC/12/QRBW/173).

Instrument

The survey was designed by the chief investigator and a research nurse who specialises in conducting IVD trials. The survey was reviewed by the Intravenous Access Research Council and then trialled by two survey teams, on two separate occasions, before survey day. After each review, assessment items were modified and reordered to improve clarity and ease of use.

The survey consisted of 25 assessment items relating to devices and documentation. Assessment items included the type, number and purpose of devices in situ, the presence and condition of dressings and/or other securements, the visibility of the insertion site, site location and by whom the catheter was inserted, and evidence of complications and documentation on the daily patient care record and medication chart. …

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