New standard of care for peripheral intravenous catheters

A new clinical care standard is expected to improve patient experience surrounding peripheral intravenous catheters (PIVC).

Released on Wednesday 26 May, the Management of Peripheral Intravenous Catheters Clinical Care Standard by the Australian Commission on Safety and Quality in Health Care (the Commission) outlines 10 statements to improve patient care and reduce complications with PIVCs.

They include:  

  • Assess intravenous access needs.
  • Inform and partner with patients.
  • Ensure competency.
  • Choose the right insertion site and PIVC.
  • Maximise first insertion success.
  • Insert and secure.
  • Document decisions and care.
  • Routine use: inspect, access and flush.
  • Review ongoing need.
  • Remove safely and replace if needed.

The new standard is set to improve the care of 7.7 million Australians who receive IV cannulas or ‘drips’ each year.

For nurse and vascular access expert Dr Evan Alexandrou, Senior Lecturer at Western Sydney University and Clinical Nurse Consultant at Liverpool Hospital in NSW, the new PIVC standard offers the chance to review the procedure in hospitals across the country.

“Peripheral intravenous catheter insertion is one of the most practiced clinical procedures in hospitals, yet it carries the greatest risk of failure of any medical device,” Dr Alexandrou said.

“Each day, thousands of PIVCs fail in Australian hospitals, and we continue to accept this unacceptable rate of failure.”

Data suggests almost 70% of cannulas need to be removed because of complications. This can include blockage and dislodgement; redness, pain or swelling of the vein; or line-related bloodstream infections. 

Dr Alexandrou said the new standard is “a way of re-setting our approach”. He said this includes reducing the burden of multiple cannulation attempts on patients, as well as questioning whether a cannula is necessary.

Research suggests first insertion attempts fail in up to 40% of adults, and up to 65% in children. In addition, between 4% and 28% of PIVCs inserted are not needed. This increases to 50% in the emergency department, where a PIVC is often inserted ‘just in case’.

Speaking during the launch webcast, Associate Professor Amanda Walker, Commission Clinical Director, said too often a decision is made to insert a peripheral intravenous device for a drug or treatment that could be provided via an alternate method.

“When people ask why we need this new standard, my answer is simple: ‘patients are not pin cushions’. It doesn’t matter where a clinician fits in the health system, we all have a responsibility to improve patient outcomes,” A/Professor Walker said, which also includes having processes in place for support and escalation where required.

“Asking for help isn’t failing. It’s putting patients first.”

Anaesthetist and Pain Medicine Specialist at St Vincent’s Hospitals in Sydney, Dr Jennifer Stevens, also spoke of the importance of location.

“The site of the cannula makes a big difference. For example, a cannula in the elbow crease is painful, makes sleep impossible when the occlusion alarm keeps going off all night, doesn’t last long and is more prone to infections,” Dr Stevens said.

This is a view shared by infectious diseases physician and microbiologist, Professor Peter Collignon AM.

While acknowledging sometimes cannulas are inserted in an emergency, resulting in less-than-ideal placement, Professor Collignon said once a patient is stabilised it should be taken out and put in a more comfortable place that is safer, whether done in theatre or on the ward.

NSW Chief Nursing and Midwifery Officer Jacqui Cross said having a nationalstandard is a positive starting place for improving care for all patients that need a cannula. She said it will help reduce complications and provide clear direction for clinical staff.

The new clinical care standard has been endorsed by 19 medical and nursing colleges and other professional bodies.