An Evidence-Based Practice Project to Improve Securement and Visualization of Peripheral Intravenous Catheters in Pediatric Patients

Smith, Andrea

Monday, 31 October 2011: 10:20 AM

Andrea Smith, PhD, RN, CPNP
Nursing Administration, Cook Children's Medical Center, Fort Worth, TX
Terri Pearcy, RN, BSN, CPN
OutPatient Surgery, Cook Children's Medical Center, Fort Worth, TX
Melodie Davis, MSN, RN
Education Department, Cook Children's Medical Center, Fort Worth, TX
Suzanne M. Frey, RN, BSN
NICU, Cook Children's Medical Center, Fort Worth, TX
Valerie J. Badgett, RN, BSN
Cardiac/Renal Unit, Cook Children's Medical Center, Fort Worth, TX
Shirley D. Martin, RN, BSN, CPN
Surgical Services, Cook Children"s Medical Center, Fort Worth, TX
Robert Elkin Hill, JD, RN, BSN
Vascular Access, Cook Children's Medical Center, Fort Worth, TX
Leigh Anne Campbell, BSN, CPN
TCU/RCU, Cook Children's Medical Center, Fort Worth, TX
Jill Isaacson, RN, BSN
Vascular Access Team, Cook Children"s Medical Center, Fort Worth, TX
Mollie D. Kuchta, RN, BSN
Quality Improvement/Accreditation, Cook Children's Medical Center, Fort Worth, TX

Learning Objective 1: The learner will be able to state key evidence-based practices identified to improve visualization and securement of PIVs in pediatric patients.

Learning Objective 2: The learner will be able to describe the process and outcomes of an EBP project to improve securement and visualization of PIVs in pediatric patients

Problem: Securement and visualization of peripheral intravenous catheter sites (PIV) is a common problem for pediatric nurses worldwide because infiltration of IV fluid can lead to serious complications. Quality data, staff nurse, and nursing administration concerns about lack of visualization of PIV sites led to the need to identify best evidence for securing PIVs so they could be easily assessed. An evidence-based practice (EBP) team representing a wide variety of units was assembled to conduct the project.

EBP Model: The IOWA Model of EBP was used to guide the project.

Method: The team conducted a comprehensive search of on-line databases locating over 30 research and non-research articles. Following critique and synthesis, the team identified key EBP: 1) use of clear dressings & tape, 2) use of catheter stabilization devices, 3) use of IV protectors, 4) labeling of dressings, & 5) hourly rounding to assess PIVs. A baseline audit of 90 PIVs on varying units identified the following current practice: 40% of the PIV sites were not visible, clear dressings were only used 40% of time, IV protectors were used in 11.7% of the PIVs, no catheter stabilization devices were used, and mean duration of PIV was 38.2 hrs. A pilot to test the evidence change in practice was implemented on 65 PIVs on 2 medical surgical units using an IV start kit manufactured to contain the EBP materials.
Outcomes: Following successful pilot testing and staff education, the new EBP bundle was initiated house wide. Outcomes 6 months post implementation indicated strong improvement in practice – 95% of sites were clearly or easily visible, IV protectors used in 81% of IVs, clear dressings used 92%, catheter stabilization devices used 74%, and mean duration of IV increased to 62.9 hrs. IV infiltration data indicated decreasing severity with earlier recognition and removal of IVs.

See more of: EBP Projects in Diverse Clinical Settings
See more of: Oral Paper & Poster: Evidence-Based Practice Contest