Tuesday, October 30, 2012

IV Restarts-Are they plaguing your Staff?

3.8 million central venous catheters (CVCs)....

2 million peripherally inserted central catheters (PICCs).....

and 310 million peripheral intravenous devices sold yearly in the US......

 
"Based on average salary and benefits for an RN, the average time of 36 minutes for a nurse to trouble shoot and restart a PIV translates to a labor cost of an estimated $22.79 per incident (Rosenthal, 2005)."
 
Vascular access and Infusion Therapy is clearly a high priority and nurses take a lot of time performing these procedures for our patients. Getting the right vascular access device placed early in the hospital stay can speed treatment and patient discharge while minimizing cost as well as restarts.
 
Maintaining the health of our patients veins and arteries has become an important issue as patients now come to hospitals more acutely ill, living longer, often having chronic conditions. According to the Centers for Disease Control (CDC) selection of the right device inserted into the right location is paramount to reducing complications, specifically infection.

Selecting the correct device is based upon the patients diagnosis, infusion therapy needs, and the length of time the patient will need these treatments and/or medications. Once the correct device is selected, assessment of the patients needs as well as the patients veins is essential.



If the device is a central line has your staff followed CDC recommendations in using Central Line Bundles. Central Line Bundles should be applied to all care and maintenance procedures.


Peripheral intravenous starts are the most common invasive procedure amongst hospitalized patients in America as about 310 million Americans receive a Peripheral IV while during their hospital stay.
 
Before 2012; nurses and facilities were typically require to change a patients IV site every 72-96 hours as recommended by the Standards of Practice of the Infusion Nurses Society.  However, as of 2012 the Infusion Nurses Society recommends that IV sites be changed as clinically indicated by the nurse.  However, what does clinically indicated mean?  We have asked over 100 nurses and each of them has given us a different answer.  None of their responses have been quite consistent.
 

Training

 
It is important to have annual training in IV Therapy and the new standards of practice in order to maintain their competency as well as a consistency in this procedure that may cost patients as well as hospitals a lot of time and money. Nurses need to understand what clinically indicated means and when to apply them to real life situations.  They also need to understand the medications they are administering through the venous access devices whether peripherally or centrally. 
Do your nurses understand that the osmolarity of medications and fluids matter? Do they understand the importance of the medications Ph? Do they know the medications dosage, contraindications, and more? Are you nurses securing the IV catheter with the proper device? Are they selecting a good vein as well as the proper location?  All of these issues play into restarts.
 
 

 

 

 

References

 
  1. McNeill EE, Hines NL, Phariss R. A clinical trial of a new all-in-one peripheral-short catheter. J Assoc Vascular Access. 2009;14(1):46-51.
  2. Rosenthal, K. (2005). Get a hold on costs and safety with securement devices. Nursing Management. 36(5). 52-53.
  3. Smith B. Peripheral intravenous catheter dwell times: a comparison of 3 securement methods for implementation of a 96-hour scheduled change protocol. J Infus Nurs. 2006;29(1):14-17.
  4. Infusion Nurses Society. Infusion nursing standards of practice. Journal of Infusion Nurs.
  5.