Rationale Review of Literature Background PICO Question The high risk obstetric patient have prolonged hospitalizations Many of our patients require a site change every hours which resulted in poor venous availability for access at the time of emergent medical need. This creates the potential for no available peripheral IV access and increased risk for central line placement, which can lead to further complications associated with central lines in this vulnerable population. Patients are dissatisfied with the pain associated with frequent IV site placement. Nurses questioned the rationale for re-accessing a site that functioned properly and didn’t display clinical indications for a restart. This increased the bedside nurse’s workload, as well as increased supply cost. Current practice varied from leaving the PIV out due to poor vasculature, changing the PIV routinely, or calling the physician to leave the PIV until painful, reddened, or swollen. I Changing Practice for Peripheral IV Sites From “Every 72 Hours” to “As Clinically Indicated” Karni Olsen, BSN, RNC, Ronda Coultrap, RNC, Teresa Sharkey, BSN, RNC, Melinda Marra, RN, Alma Martinez, RN, Chris Tussey, RNC,CNS; Ann Earhart, RN, PhD(c), ACNS-BC, CRNI Implementation Plan Discussion Baseline Data Methods Staff developed and provided input and education of the data required for baseline data of IV practices. Forms and processes were developed by staff for data collection throughout the patient’s stay from admission to discharge to capture the IV site insertion assessment. Data included site location, length of time in place, medications administered, and reason for IV removal. Education was provided to the staff to stress the importance of accurate IV documentation on the electronic medical record for data collection. The Infusion Nurses’ Society phlebitis scale is incorporated into the documentation and provided a consistent method to document and measure redness and pain at Baseline data was collected for 5 months Bright colored folders created for data collection CNS and leadership reminded staff of data collection No change in IV rotation was made during Baseline data collection. Literature and internal data will be presented to Physician Committees With approval, implement practice/policy changed to removing and replacing peripheral IV only when clinically indicated after baseline data collected. Post implementation, data collected to analyze change in practice. This program helped identify baseline data of multiple practices. The project for change in practice occurred due to the strong support by nursing staff. The project identified routine IV restarts occurring for patients being discharged in the following day, as well as nursing assessment of IV sites being changed as needed when red and swollen before the three days. The pain and swelling increased as this was the clinical indication for change The patient satisfaction increased, with patients having IVs in place days without routine changes Cost of supplies for reinsertion decreased. Plan implementation into next area, telemetry/PCU, a different patient population for validation of results. Contact Information Karni Olsen, BSN, RNC – Rhonda Coultrap, Routine practice for care and maintenance of peripheral intravenous (PIV) sites includes routine restarting every hours. Nursing identified needing to change PIVs for all patients, which is difficult for the high risk OB patient who can remain hospitalized for weeks and months during a complicated pregnancy. In the high risk OB patients who are admitted and staying longer than 4 days needing a PIV, how does changing the IV site when clinically needed versus the current practice of changing the IV site every hours affect phlebitis rates, patient satisfaction, and cost? A Cochrane Review “Clinically-Indicated Replacement Versus Routine Replacement of Peripheral Venous Catheters” by Webster, Osborne, Rickard, and Hall (2010) found no statistical increase in 5 different clinical trials in phlebitis (9% versus 7.2%) when changing PIV sites when clinically indicated versus every hours. The findings also found increased patient and nursing satisfaction, as well as decreased cost of supplies. Rickard, C., McCann, D. Munnings, J. & McGrail, M. (2010). Routine resite of peripheral intravenous devices every 3 days did not reduce complications compared with clinically indicated resite: A randomized controlled trial. BMC Medicine, 8(53), Webster. J., Lloyd, S., Hopkins, T., Osborne, S., & Yaxley, M. (2007). Developing a research base for intravenous cannula re-sites (DRIP trial). A randomized controlled trial of hospital in- patients. Science Direct, 44, IV sites n-27 IV location: hand n-7, forearm n-7, wrist n-7, AC-n-5 Insertion attempts: (1) n-23; (2) n-3; (3) n-1. Average days in place: 3.9 days Reason Removed: painful n-5, discharge n-10, routine change n-12 Implementation Data IV sites n-31 IV location: hand n-5, forearm n-14, wrist n-7, AC-n-5 Insertion attempts: (1) n-23; (2) n-5; (3) n-2; (5) n-1. Average days in place: 7.4 days Reason Removed: painful n-8, swelling n-4, leaking n-1, dislodged n-5, discharged n-13.