Decreasing the Failure of Peripheral Intravenous Catheters Using Care Bundles: A Quality Improvement Initiative
Introduction
Background: Peripheral Intravenous catheters are an essential and basic partofhealth care and the management of hospitalised patients. 1.1 Marshetal., in their observational prospective cohort study documented a highfailure rate, in some cases up to 69% of premature failures, however,Helm et al., cited a 35-50% failure rate. 1.2, 2 Improperperipheralintravenous catheter (PIVC) placement had a 38% associationwithcatheter associated blood stream infections (CABSI), which quiteoftencontribute to lengthy hospital stays and increase patientdiscomfort. 3
Objectives
Objective: The primary goal of this quality improvement is to determinethefailure rate of PIVC at the Georgetown Public HospitalCorporation(GPHC) on the female medical ward and implement carebundles todecrease our failure rate by at least 10% in comparison tothe averagefailure rate of 69% over a period of eight weeks.
Method
Methods : The model for improvement approach was implemented using threeplan-do-study-act (PDSA) cycles. Each cycle included all patientsadmittedto the female medical ward (GPHC) of over a period ofsixteen days. Weused a bundle care approach, defined as having anupper limit of fiveevidence-based practises implemented entirely. 4We employed theacronym SECURE. 1) select an appropriate site; 2)use 70% alcohol swabsto clean; 3) use a catheter with a gauge of 20 or less; 4) use hypafixadhesivedressing tape to secure the catheter; 5) remember to handlewith care; 6) educate patient on how to care for their PIVCs.
Results
Results & Conclusion: At the close of the PDSA cycles we were able to determine a50.8%failure rate which was a more than 10% decline in the averagerate.However, we did not establish a local PIVC failure rate due tomultipleextenuating factors. Secondary end points identified theprimarydrivers of PIVC failures as infiltration, mishandling bypatients,mishandling by health care professionals, and poor adhesivematerial.