By Dr Josephine Lovegrove, NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University; School of Nursing, Midwifery and Social Work, UQCCR and The University of Queensland; and Dr Gillian Ray-Barruel, Herston Infectious Diseases Institute, Metro North Health; School of Nursing, Midwifery and Social Work, UQCCR and The University of Queensland
Improving peripheral intravenous catheter care and documentation
Peripheral intravenous catheters (PIVCs) are extensively used in hospitals. Because they are seen as innocuous devices, however, their care is often not prioritised.
Point prevalence research has shown that PIVC insertion site care and assessments are often missed, dressing integrity is poor, and documentation is frequently lacking (Alexandrou et al., 2018), which commonly leads to complications and device failure.
Once intravenous treatment is complete, PIVCs are often left ‘idle’ (in place without a reason for extended time periods), increasing the risk of patient harm (Becerra et al., 2016).
Therefore, PIVCs must be recognised as invasive medical devices with the potential for adverse events, including life-threatening bloodstream infections.
Appropriate assessment and care of PIVCs is therefore essential.
The I-DECIDED* device assessment and decision tool
The I-DECIDED tool is a point-of-care, mnemonic tool developed to address the inadequate care associated with devices such as PIVCs.
This structured tool comprises eight items based on evidence and best-practice guidelines.
The items guide care and clinical decision-making from identifying the presence of a device and evaluating its ongoing need, to continuation of therapy, complication management or device removal, and documentation of the decision to continue or remove the device.
While the I-DECIDED tool may be used for any invasive device, it was recently tested for PIVCs in seven wards across three Australian hospitals (Ray-Barruel et al., 2023).
A total of 867 PIVCs in 825 patients were assessed before and after implementation of the tool.
Following implementation, the numbers of ‘idle’ PIVCs and sub-standard dressings (e.g., those that were lifting or soiled) were reduced. Insertion site complications, such as pain, redness and swelling, also decreased.
With use of the tool, more patients reported their nurse had assessed their PIVC in the last eight hours, performed hand hygiene, and scrubbed the needleless connector before use.
Documentation improved across all I-DECIDED components, except one (identify the presence of a PIVC) where documentation was already high.
The I-DECIDED tool has the potential to improve clinical care and documentation to align with best-practice recommendations.
It provides important reminders around insertion site assessment and care, maintaining effective dressings, and promptly removing unneeded PIVCs and those with early signs of complications.
Remember, PIVCs are invasive and a potential source of harm, and from a legal standpoint, care that isn’t documented didn’t happen.
Using the I-DECIDED tool for PIVC assessment, care and documentation can improve patient outcomes.
Further information is available at www.avatargroup.org.au/i-decided.html
I - IDENTIFY if a device is present
D - DOES the patient need the device? If no longer in active use, consider device removal.
E - EFFECTIVE function? Is the device functioning as intended? If not, troubleshoot as per policy or remove device.
C - COMPLICATION-FREE? If complications are noted, troubleshoot or remove device.
I - INFECTION prevention: Hand hygiene before and after patient and device care. Careful handling and disinfection of device access points.
D - DRESSING and securement: Ensure dressings are clean, dry and intact. Secure devices to prevent tugging or patient injury.
E - EVALUATE & EDUCATE: Discuss device plan with patient and family. Educate as needed.
D - DOCUMENT YOUR DECISION: Continue, troubleshoot, change dressing, or remove device.
Always consider local policy and consult with team and patient as required.
References
Alexandrou, E., Ray-Barruel, G., Carr, P. J., Frost, S. F., Inwood, S., Higgins, N., Lin, F., Alberto, L., Mermel, L., Rickard, C. M. & OMG Study Group. (2018). Use of short peripheral intravenous catheters: Characteristics, management, and outcomes worldwide.
Journal of Hospital Medicine, 13(5), E1-E7. https://doi.org/10.12788/jhm.3039
Becerra, M. B., Shirley, D. & Safdar, N. (2016). Prevalence, risk factors, and outcomes of idle intravenous catheters: An integrative review.
American Journal of Infection Control, 44(10), e167-e172. https://doi.org/10.1016/j.ajic.2016.03.073
Ray-Barruel, G., Chopra, V., Fulbrook, P., Lovegrove, J., Mihala, G., Wishart, M., Cooke, M., Mitchell, M. & Rickard, C. M. (2023). The impact of a structured assessment and decision tool (I-Decided) on improving care of peripheral intravenous catheters: A multicenter, interrupted time-series study.
International Journal of Nursing Studies, 148, 104604. https://doi.org/10.1016/j.ijnurstu.2023.104604
Reflective questions
1. Why is regular PIVC assessment important?
2. When should PIVCs be removed?
3. Why should PIVC care be documented?
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD
*I-DECIDED is a registered trademark of Griffith University.